Provider Demographics
NPI:1215248570
Name:COMMUNITY RESIDENCES, INC.
Entity type:Organization
Organization Name:COMMUNITY RESIDENCES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. ADMINISTRATION, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-842-2321
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:703-842-2334
Mailing Address - Fax:703-842-2341
Practice Address - Street 1:7477 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3504
Practice Address - Country:US
Practice Address - Phone:410-760-2250
Practice Address - Fax:410-760-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management