Provider Demographics
NPI:1063782662
Name:COMMUNITY RESIDENCES INC.
Entity type:Organization
Organization Name:COMMUNITY RESIDENCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY BASED SVCS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGUDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-878-6858
Mailing Address - Street 1:732 WEST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2329
Mailing Address - Country:US
Mailing Address - Phone:860-621-7600
Mailing Address - Fax:
Practice Address - Street 1:205 KELSEY ST
Practice Address - Street 2:UNIT 12
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-5436
Practice Address - Country:US
Practice Address - Phone:860-878-6858
Practice Address - Fax:860-665-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0520261QM0850X
CT0432261QR0405X
CTOPCC68261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder