1396149985 NPI number — COMMUNITY OPTIONS, INC.

Table of content: (NPI 1396149985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396149985 NPI number — COMMUNITY OPTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY OPTIONS, 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:
1396149985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 FARBER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-5913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-951-9900
Provider Business Mailing Address Fax Number:
609-951-9112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5751 UPTAIN RD
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37411-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-892-0022
Provider Business Practice Location Address Fax Number:
423-892-7910
Provider Enumeration Date:
10/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
STACK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CEO & PRESIDENT
Authorized Official Telephone Number:
609-951-9900

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  L000000012772 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00677 . This is a "DEPARTMENT OF INTELLECTUAL & DEVELOPMENTAL DISABILITIES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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