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Community Residence, Inc.
Adult Care Home Facility in Licking, Missouri
NPI 1275530776

Community Residence, Inc. is an Adult Care Home Facility based in Ballwin, MO and is specialized in Adult Care Home. Community Residence, Inc. practices in Licking, MO. The NPI Number for Community Residence, Inc. is 1275530776 and holds a License No. 030734 (Missouri).

The current practice location address for Community Residence, Inc. is 225 W Highway 32, Licking, MO and can be reached out via phone at 573-674-2207 and via fax at 573-674-2239.

Location: 225 W Highway 32, Licking, MO, 63021-5248
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1275530776
Provider Name
Community Residence, Inc.
Credential
Provider Entity Type
Organization
Address
225 W Highway 32, Licking, MO, 63021-5248
Phone Number
573-674-2207
Fax Number
573-674-2239
Provider Enumeration Date
06/30/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
266178706 05 MO
institution
Provider Business Practice Location Address Details
Address
225 W Highway 32
City
Licking
State
Missouri
Zip
65542-9832
Phone Number
573-674-2207
Fax Number
573-674-2239
person
Provider Business Mailing Address Details
Address
225 W Highway 32
City
Licking
State
Missouri
Zip
65542-9832
Phone Number
573-674-2207
Fax Number
573-674-2239
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Custodial Care Facility
Speciality
Adult Care Home
Taxonomy
311ZA0620X
License No.
030734 (Missouri)
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
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