1124025705 NPI number — COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC

Table of content: (NPI 1124025705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124025705 NPI number — COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124025705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
452 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14202-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-883-8888
Provider Business Practice Location Address Fax Number:
716-883-2065
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FOLEY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
716-883-8888

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251C00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251B00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01492135 . This is a "IRE WAIVER DAY HABILITATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01997699 . This is a "NON-WAIVE/ISS SERVICE COO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02591739 . This is a "WAIVER HOURLY RESPITE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02171846 . This is a "WAIVER SUPPORTIVE EMPLOYM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01997699 . This is a "WAIVER MSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02161508 . This is a "GROUP & INDIVIDUAL FAMILY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01492135 . This is a "WAIVER/HCBS RESIDENTIAL H" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01750334 . This is a "1377 ABBOTT RD DAY HABILI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01750334 . This is a "ISE WAIVER RESIDENTAIL HA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02161508 . This is a "ACT WAIVER DAY HABILITATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01492135 . This is a "SENIOR DAY WAIVER DAY HAB" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01750334 . This is a "PACT WAIVER RESIDENTIAL H" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02253469 . This is a "WAIVER SERVICE IRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02588663 . This is a "WAIVER BAKOS IRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01750334 . This is a "1845 GENESEE NON DD DAY H" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01492135 . This is a "WAIVER/HCBS DAY HABILITAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02253487 . This is a "WAIVER SUPPORTIVE IRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02599833 . This is a "WAIVER LAKE IRA" identifier . This identifiers is of the category "OTHER".




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