MEDICARE: COMMUNITY OPTIONS ENTERPRISES, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1790133593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OPTIONS ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	16 FARBER RD
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5913
Country	:	US
Telephone Number	:	609-951-9900
Fax Number	:	609-951-9112

Provider Business Practice Location Address
First Line	:	390 MAIN RD
Second Line	:
City	:	MONTVILLE
State	:	NJ
Zip	:	07045-9785
Country	:	US
Telephone Number	:	609-951-9900
Fax Number	:	609-951-9112

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. ROBERT P STACK
Credential	:	MA
Telephone Number	:	609-951-9900

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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