Provider Demographics
NPI:1639240971
Name:DEPAUL COMMUNITY RESOURCES
Entity Type:Organization
Organization Name:DEPAUL COMMUNITY RESOURCES
Other - Org Name:DEPAUL FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:540-265-8923
Mailing Address - Street 1:5650 HOLLINS RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-5056
Mailing Address - Country:US
Mailing Address - Phone:540-265-8923
Mailing Address - Fax:540-206-1007
Practice Address - Street 1:5650 HOLLINS RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-5056
Practice Address - Country:US
Practice Address - Phone:540-265-8923
Practice Address - Fax:540-265-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 253J00000X, 372600000X, 3747P1801X, 385H00000X
VA02302006251S00000X
VA02301001251S00000X
VA02303001251S00000X
VA02303002251S00000X
VA02305001251S00000X
VA02308001251S00000X
VA02309001251S00000X
VA02310001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004947215Medicaid
VA010050197Medicaid
VA010050391Medicaid
VA010050413Medicaid
VA010050383Medicaid
VA004945930Medicaid
VA010050359Medicaid
VA010050430Medicaid
VA010050367Medicaid
VA004947509Medicaid