OrganizationActive
Community Residences, Inc.
NPI 1104902469 · Intellectual Disabilities Intermediate Care Facility · Annandale, VA
Provider details
- NPI number
- 1104902469
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Terry Hurley, Vp Admin, Cfo
- License
- 05801001 (VA)
Practice location
8518 Queen Elizabeth Blvd
Annandale, VA 22003-4308
Phone: (703) 842-2333
Fax: (703) 842-2311
Mailing address
14160 Newbrook Dr
Chantilly, VA 20151-2297
Registry dates
- Enumerated
- 2006-10-30
- Last updated
- 2018-01-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.