NPI 1275530776

Community Residence, INC.

Organisation Adult Care Home Facility Licking, MO

Practice location

Address: 225 W Highway 32, Licking, MO 65542-9832
Phone: (573) 674-2207
Fax: (573) 674-2239
Mailing address: 312 Solley Dr Rear, Ballwin, MO 63021-5248

Authorised official

Name: James Giardina
Title: President
Phone: (636) 394-3000

Registered specialties

Adult Care Home Facility Primary

Nursing & Custodial Care Facilities Taxonomy 311ZA0620X Licence 030734 (MO)

Other Custodial Care Facility providers in Missouri →

Registry record

NPI: 1275530776
Entity type: Organization
NPI issued: 30 Jun 2005
Record last updated: 13 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.