Organization · Type 2 NPI
Community Residence, Inc.
Adult Care Home Facility · Mount Vernon, MO
NPI number
1669479150
Active
Practice location
1425B S Landrum St
Mount Vernon, MO 65712-1912
Fax (417) 466-4909
Mailing address
312 Solley Dr, Rear
Ballwin, MO 63021-5248
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Care Home Facility Primary | 311ZA0620X | 029793 (MO) |
Adult Care Home Facility: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
About NPI 1669479150
Community Residence, Inc.'s National Provider Identifier is 1669479150, issued on Jun 30, 2005. The primary taxonomy on file is Adult Care Home Facility (311ZA0620X), and the practice location is in Mount Vernon, MO. The record was last updated on Oct 30, 2007.