OrganizationActive
Community Residence, Inc.
NPI 1275530776 · Adult Care Home Facility · Licking, MO
Provider details
- NPI number
- 1275530776
- Entity type
- Organization
- Primary specialty
- Adult Care Home FacilityNursing & Custodial Care Facilities
- Parent organization
- Community Residence, Inc
- Organization subpart
- Yes
- Authorized official
- James Giardina, President(636) 394-3000
- License
- 030734 (MO)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
225 W Highway 32
Licking, MO 65542-9832
Phone: (573) 674-2207
Fax: (573) 674-2239
Approximate (ZIP-level) locationGet directions
Mailing address
312 Solley Dr
Ballwin, MO 63021-5248
Other names (DBA / former)
- Doing business as
- Licking Residential Care
Registry dates
- Enumerated
- 2005-06-30
- Last updated
- 2008-06-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.