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	:	1902309198
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	:	609-919-3889

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

Authorized Official
Title or Position	:	CONTROLLER
Name	:	BELGICA VICTORIA CEDENO
Credential	:
Telephone Number	:	609-951-9900

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	03/14/2018

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