Provider Demographics
NPI:1881045961
Name:COMMUNITY RESIDENCES, INC.
Entity Type:Organization
Organization Name:COMMUNITY RESIDENCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-842-2327
Mailing Address - Street 1:14160 NEWBROOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2297
Mailing Address - Country:US
Mailing Address - Phone:703-842-2327
Mailing Address - Fax:703-842-2341
Practice Address - Street 1:12320 PARKLAWN DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1726
Practice Address - Country:US
Practice Address - Phone:301-693-6875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management