Provider Demographics
NPI:1124424072
Name:CHEMLU DEVELOPMENTAL DISABILITIES CENTER, INC
Entity type:Organization
Organization Name:CHEMLU DEVELOPMENTAL DISABILITIES CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PINCHES
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-774-1422
Mailing Address - Street 1:PO BOX 2100
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10949-8600
Mailing Address - Country:US
Mailing Address - Phone:845-774-1422
Mailing Address - Fax:845-783-2237
Practice Address - Street 1:2 GARFIELD RD STE 301-A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-774-1422
Practice Address - Fax:845-853-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1386251S00000X
NY43480251X00000X, 253Z00000X, 385H00000X, 385HR2060X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02382130Medicaid
NY02704570Medicaid
NY02382130Medicaid
NY02712389Medicaid