Healthcare Provider Details

I. General information

NPI: 1770797623
Provider Name (Legal Business Name): COMMUNITY OPTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ANDREA ST SUITE 201
BOWLING GREEN KY
42104-3382
US

IV. Provider business mailing address

16 FARBER RD
PRINCETON NJ
08540-5913
US

V. Phone/Fax

Practice location:
  • Phone: 270-780-9330
  • Fax: 270-780-9332
Mailing address:
  • Phone: 609-951-9900
  • Fax: 609-799-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number33001520
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number33001520
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number33001520
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number33001520
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number33001520
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number7100095010
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number7100095010
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number7100095010
License Number StateKY
# 9
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number7100095010
License Number StateKY

VIII. Authorized Official

Name: MR. ROBERT P. STACK
Title or Position: PRESIDENT & C.E.O.
Credential: B.S., M.A.
Phone: 609-951-9900