Healthcare Provider Details

I. General information

NPI: 1124424072
Provider Name (Legal Business Name): CHEMLU DEVELOPMENTAL DISABILITIES CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GARFIELD RD STE 301-A
MONROE NY
10950
US

IV. Provider business mailing address

PO BOX 2100
MONROE NY
10949-8600
US

V. Phone/Fax

Practice location:
  • Phone: 845-774-1422
  • Fax: 845-853-1014
Mailing address:
  • Phone: 845-774-1422
  • Fax: 845-783-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number43480
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1386
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number43480
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number43480
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number43480
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number43480
License Number StateNY

VIII. Authorized Official

Name: PINCHES JAKOBOWITZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 845-774-1422