Provider Demographics
NPI:1760671150
Name:COMMUNITY RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:COMMUNITY RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FITZROY
Authorized Official - Middle Name:BARRINGTON
Authorized Official - Last Name:EDMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-319-9924
Mailing Address - Street 1:14675 COPELAND WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0000
Mailing Address - Country:US
Mailing Address - Phone:352-345-4250
Mailing Address - Fax:
Practice Address - Street 1:14675 COPELAND WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34604-0000
Practice Address - Country:US
Practice Address - Phone:352-345-4250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities