Provider Demographics
NPI:1558898288
Name:COMMUNITY RESIDENCES, INC.
Entity Type:Organization
Organization Name:COMMUNITY RESIDENCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ADMIN, CFO
Authorized Official - Prefix:
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 STE 100
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:703-842-2341
Practice Address - Street 1:600 WASHINGTON AVE STE 100-D
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3913
Practice Address - Country:US
Practice Address - Phone:410-760-2250
Practice Address - Fax:410-760-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid