Healthcare Provider Details

I. General information

NPI: 1124025705
Provider Name (Legal Business Name): COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 DELAWARE AVE
BUFFALO NY
14202-1515
US

IV. Provider business mailing address

452 DELAWARE AVE
BUFFALO NY
14202-1515
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-8888
  • Fax: 716-883-2065
Mailing address:
  • Phone: 716-883-8888
  • Fax: 716-883-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. MARK R FOLEY
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 716-883-8888