Healthcare Provider Details

I. General information

NPI: 1124195904
Provider Name (Legal Business Name): COMMUNITY BASED SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 FIELDS LN
NORTH SALEM NY
10560-1001
US

IV. Provider business mailing address

3 FIELDS LN
NORTH SALEM NY
10560-1057
US

V. Phone/Fax

Practice location:
  • Phone: 914-277-4771
  • Fax: 914-277-8956
Mailing address:
  • Phone: 914-277-4771
  • Fax: 914-277-8956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number01154030
License Number StateNY

VIII. Authorized Official

Name: ROSEMARIE STASIAK
Title or Position: CFO
Credential: CPA
Phone: 914-236-1160