MEDICARE: COMMUNITY BASED SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	00704816	NY

General Provider Information

NPI Number	:	1538231139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY BASED SERVICES, INC.

Provider Business Mailing Address
First Line	:	3 FIELDS LN
Second Line	:
City	:	NORTH SALEM
State	:	NY
Zip	:	10560-1001
Country	:	US
Telephone Number	:	914-277-4771
Fax Number	:	914-277-8956

Provider Business Practice Location Address
First Line	:	264 BRYANT AVE APT B
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2106
Country	:	US
Telephone Number	:	914-997-1863
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. MARGOT A ANDERSON
Credential	:
Telephone Number	:	914-277-4771

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/22/2020

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