MEDICARE: COMMUNITY OPTIONS, 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	251B00000X	Case Management Agency	TX
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	TX
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	TX

General Provider Information

NPI Number	:	1639379779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OPTIONS, INC.

Provider Business Mailing Address
First Line	:	16 FARBER RD
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5913
Country	:	US
Telephone Number	:	609-951-9900
Fax Number	:	609-779-8960

Provider Business Practice Location Address
First Line	:	4004 BELT LINE RD
Second Line	:	SUITE 120
City	:	ADDISON
State	:	TX
Zip	:	75001-4370
Country	:	US
Telephone Number	:	972-503-3901
Fax Number	:	972-503-3898

Authorized Official
Title or Position	:	PRESIDENT & C.E.O.
Name	:	MR. ROBERT STACK
Credential	:	B.S., M.A.
Telephone Number	:	609-951-9900

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	10/27/2007

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Directions to “COMMUNITY OPTIONS, INC. ” Practice Location

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