Organization
COMMUNITY RESIDENCES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JAYNE PANEK (PROJECT IMPLEMENTATION MANAGER)
(703) 842-2327
Entity
Organization
Contact information
Practice address
1612 N MCKINLEY RD, ARLINGTON, VA 22205-2237
(703) 842-2333
(703) 842-2311
Mailing address
14160 NEWBROOK DR, CHANTILLY, VA 20151-2297
(703) 842-2333
(703) 842-2311
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
05801001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010137284
—
VA
Enumeration date
10/30/2006
Last updated
01/09/2018
Update your record
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