Provider Demographics
NPI:1275651325
Name:OPTIONS FOR COMMUNITY LIVING, INC.
Entity Type:Organization
Organization Name:OPTIONS FOR COMMUNITY LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBANO-GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, MHA
Authorized Official - Phone:631-361-9020
Mailing Address - Street 1:25 HOWARD PL
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7206
Mailing Address - Country:US
Mailing Address - Phone:631-361-9020
Mailing Address - Fax:631-361-9192
Practice Address - Street 1:25 HOWARD PL
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7206
Practice Address - Country:US
Practice Address - Phone:631-361-9020
Practice Address - Fax:631-361-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01304154Medicaid