Provider Demographics
NPI:1124025705
Name:COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC
Entity Type:Organization
Organization Name:COMMUNITY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-883-8888
Mailing Address - Street 1:452 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1515
Mailing Address - Country:US
Mailing Address - Phone:716-883-8888
Mailing Address - Fax:716-883-2065
Practice Address - Street 1:452 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1515
Practice Address - Country:US
Practice Address - Phone:716-883-8888
Practice Address - Fax:716-883-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X, 251C00000X, 320600000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
01492135OtherIRE WAIVER DAY HABILITATI
01997699OtherNON-WAIVE/ISS SERVICE COO
02591739OtherWAIVER HOURLY RESPITE
02171846OtherWAIVER SUPPORTIVE EMPLOYM
01997699OtherWAIVER MSC
02161508OtherGROUP & INDIVIDUAL FAMILY
01492135OtherWAIVER/HCBS RESIDENTIAL H
01750334Other1377 ABBOTT RD DAY HABILI
01750334OtherISE WAIVER RESIDENTAIL HA
02161508OtherACT WAIVER DAY HABILITATI
01492135OtherSENIOR DAY WAIVER DAY HAB
01750334OtherPACT WAIVER RESIDENTIAL H
02253469OtherWAIVER SERVICE IRA
02588663OtherWAIVER BAKOS IRA
01750334Other1845 GENESEE NON DD DAY H
01492135OtherWAIVER/HCBS DAY HABILITAT
02253487OtherWAIVER SUPPORTIVE IRA
02599833OtherWAIVER LAKE IRA