Basic Information
Provider Information
NPI: 1508300393
EntityType: 2
ReplacementNPI:  
OrganizationName: CITIZENS OPTIONS UNLIMITED INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 189 WHEATLEY RD
Address2:  
City: GLEN HEAD
State: NY
PostalCode: 115452641
CountryCode: US
TelephoneNumber: 5166261000
FaxNumber: 5166263308
Practice Location
Address1: 915 RAINBOW COMMONS COURT
Address2:  
City: MELVILLE
State: NY
PostalCode: 117479001
CountryCode: US
TelephoneNumber: 5166261000
FaxNumber: 5166263308
Other Information
ProviderEnumerationDate: 12/13/2016
LastUpdateDate: 12/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DERR
AuthorizedOfficialFirstName: WILLARD
AuthorizedOfficialMiddleName: T
AuthorizedOfficialTitleorPosition: CHIEF FINANCIAL OFFICER
AuthorizedOfficialTelephone: 5166261000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310500000X  Y Nursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness 

No ID Information.


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