Organization
COMMUNITY RESIDENCE, INC.
Active
Parent organization
COMMUNITY RESIDENCE, INC
Other names
Licking Residential Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY RESIDENCE, INC
Authorized official
JAMES GIARDINA (PRESIDENT)
(636) 394-3000
Entity
Organization
Contact information
Practice address
225 W HIGHWAY 32, LICKING, MO 65542-9832
(573) 674-2207
(573) 674-2239
Mailing address
312 SOLLEY DR, REAR, BALLWIN, MO 63021-5248
(636) 394-3000
(636) 394-7713
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
030734
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266178706
—
MO
Enumeration date
06/30/2005
Last updated
06/13/2008
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