Healthcare Provider Details

I. General information

NPI: 1245371467
Provider Name (Legal Business Name): CHOICES FOR COMMUNITY LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 LIBERTY DR
AMSTERDAM NY
12010-5635
US

IV. Provider business mailing address

43 LIBERTY DR
AMSTERDAM NY
12010-5635
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-5080
  • Fax:
Mailing address:
  • Phone: 518-842-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KARL COTE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 518-954-3367