Provider Demographics
NPI:1639240971
Name:DEPAUL COMMUNITY RESOURCES
Entity type:Organization
Organization Name:DEPAUL COMMUNITY RESOURCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
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
251C00000X, 251B00000X, 372600000X, 385H00000X, 3747P1801X, 253J00000X
VA02302006251S00000X
VA02301001251S00000X
VA02303001251S00000X
VA02303002251S00000X
VA02305001251S00000X
VA02308001251S00000X
VA02309001251S00000X
VA02310001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004947215Medicaid
VA010050197Medicaid
VA010050391Medicaid
VA010050413Medicaid
VA010050383Medicaid
VA004945930Medicaid
VA010050359Medicaid
VA010050430Medicaid
VA010050367Medicaid
VA004947509Medicaid