Organization
COMMUNITY RESIDENCES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY JAYNE PANEK (PROJECT DIRECTOR)
(703) 842-2327
Entity
Organization
Contact information
Practice address
14160 NEWBROOK DR, SUITE 100, CHANTILLY, VA 20151-2297
(703) 842-2327
(703) 842-2341
Mailing address
14160 NEWBROOK DR, SUITE 100, CHANTILLY, VA 20151-2297
(703) 842-2327
(703) 842-2341
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
058-01-011
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421561300
—
MD
05
—
5000045761
—
VA
Enumeration date
09/14/2016
Last updated
09/14/2016
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