Provider Demographics
NPI:1770797623
Name:COMMUNITY OPTIONS, INC.
Entity type:Organization
Organization Name:COMMUNITY OPTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MA
Authorized Official - Phone:609-951-9900
Mailing Address - Street 1:16 FARBER RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5913
Mailing Address - Country:US
Mailing Address - Phone:609-951-9900
Mailing Address - Fax:609-799-8960
Practice Address - Street 1:1300 ANDREA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3382
Practice Address - Country:US
Practice Address - Phone:270-780-9330
Practice Address - Fax:270-780-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33001520251B00000X, 320900000X, 385HR2060X, 252Y00000X, 251C00000X
KY7100095010251C00000X, 252Y00000X, 385HR2060X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100122550Medicaid
KY33001520Medicaid
KY7100095010Medicaid