MEDICARE: COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	NY
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	NY
3	251C00000X	Developmentally Disabled Services Day Training Agency	NY
4	251B00000X	Case Management Agency	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	01492135	OTHER	IRE WAIVER DAY HABILITATI
2	01997699	OTHER	NON-WAIVE/ISS SERVICE COO
3	02591739	OTHER	WAIVER HOURLY RESPITE
4	02171846	OTHER	WAIVER SUPPORTIVE EMPLOYM
5	01997699	OTHER	WAIVER MSC
6	02161508	OTHER	GROUP & INDIVIDUAL FAMILY
7	01492135	OTHER	WAIVER/HCBS RESIDENTIAL H
8	01750334	OTHER	1377 ABBOTT RD DAY HABILI
9	01750334	OTHER	ISE WAIVER RESIDENTAIL HA
10	02161508	OTHER	ACT WAIVER DAY HABILITATI
11	01492135	OTHER	SENIOR DAY WAIVER DAY HAB
12	01750334	OTHER	PACT WAIVER RESIDENTIAL H
13	02253469	OTHER	WAIVER SERVICE IRA
14	02588663	OTHER	WAIVER BAKOS IRA
15	01750334	OTHER	1845 GENESEE NON DD DAY H
16	01492135	OTHER	WAIVER/HCBS DAY HABILITAT
17	02253487	OTHER	WAIVER SUPPORTIVE IRA
18	02599833	OTHER	WAIVER LAKE IRA

General Provider Information

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

Provider Business Mailing Address
First Line	:	452 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1515
Country	:	US
Telephone Number	:	716-883-8888
Fax Number	:	716-883-2065

Provider Business Practice Location Address
First Line	:	452 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1515
Country	:	US
Telephone Number	:	716-883-8888
Fax Number	:	716-883-2065

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. MARK R FOLEY
Credential	:
Telephone Number	:	716-883-8888

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/11/2025

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