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	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1720458953
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	:	609-919-3882

Provider Business Practice Location Address
First Line	:	1 IRON FORGE SQ
Second Line	:	UNIT 1
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-1737
Country	:	US
Telephone Number	:	609-951-9900
Fax Number	:	609-919-3882

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	DAVID SWEENEY
Credential	:	MBA, CPA
Telephone Number	:	609-951-9900

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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