Provider Demographics
NPI:1396820098
Name:COMMUNITY RESIDENCES, INC
Entity Type:Organization
Organization Name:COMMUNITY RESIDENCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ADMINISTRATION/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-842-2321
Mailing Address - Street 1:14160 NEWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2297
Mailing Address - Country:US
Mailing Address - Phone:703-842-2333
Mailing Address - Fax:703-842-2311
Practice Address - Street 1:14160 NEWBROOK DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2297
Practice Address - Country:US
Practice Address - Phone:703-842-2333
Practice Address - Fax:703-842-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA05801001, 05801003,311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004946138Medicaid