OrganizationActive
Community Residence, Inc.
NPI 1669479150 · Adult Care Home Facility · Mount Vernon, MO
Provider details
- NPI number
- 1669479150
- Entity type
- Organization
- Primary specialty
- Adult Care Home FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- James Giardina, President(636) 394-3000
- License
- 029793 (MO)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
1425b S Landrum St
Mount Vernon, MO 65712-1912
Phone: (417) 466-3649
Fax: (417) 466-4909
Approximate (ZIP-level) locationGet directions
Mailing address
312 Solley Dr
Ballwin, MO 63021-5248
Other names (DBA / former)
- Doing business as
- Mt Vernon Residential Care
Registry dates
- Enumerated
- 2005-06-30
- Last updated
- 2007-10-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.