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Provider Demographic Information - FITZMAURICE COMMUNITY SERVICES INC

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	FITZMAURICE COMMUNITY SERVICES INC
Address:	2115 N 5TH ST STROUDSBURG, PA 18360-2801
Phone:	(570) 424-6223
Fax:	(570) 424-5228
Web Site:	www.fitzmaurice.org

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	FITZMAURICE COMMUNITY SERVICES, INC.
Address:	480 CLEARVIEW LN STROUDSBURG, PA 18360-3002
Phone:	(570) 424-6223

Type:	Regional/Field Office	Counties Served:
Name:	FITZMAURICE COMMUNITY SERVICES, INC.
Address:	480 CLEARVIEW LN STROUDSBURG, PA 18360-3002
Phone:	(570) 424-6223

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Carbon/Monroe/Pike
\|Service Name / Level	\|Rate

Benefits Counseling	$13.36 / 15 min.
CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS: Community OnCall/Remote Support	$1.64 / 15 min.
Companion Services (Basic Staff Support)	$3.19 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$19.83 / 15 min.
Life Sharing-1 person-Elig-NG 1 > 30 Hrs	$171.35 / 1 Day
Life Sharing-1 person-Elig-NG 2 > 30 Hrs	$204.29 / 1 Day
Life Sharing-1 person-Elig-NG 3 > 30 Hrs	$279.58 / 1 Day
Life Sharing-1 person-Elig-NG 4 > 30 Hrs	$355.61 / 1 Day
Life Sharing-2 person-Elig-NG 1 > 30 Hrs	$120.79 / 1 Day
Life Sharing-2 person-Elig-NG 2 > 30 Hrs	$144.84 / 1 Day
Life Sharing-2 person-Elig-NG 3 > 30 Hrs	$197.06 / 1 Day
Life Sharing-2 person-Elig-NG 4 > 30 Hrs	$237.16 / 1 Day
Needs Exception Allowance (NEA)-Adult Res (6400)	$0.01 - $508.93 / 1 Day
Needs Excptn Allowance (NEA)-Adult Res (6400)-521	$0.01 - $649.64 / 1 Day
Res Hab-1 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-1 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-1 Person-NG 3-Elig	$924.89 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$746.22 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,118.74 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$822.23 / 1 Day
Res Hab-2 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-2 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-2 Person-NG 3-Elig	$685.68 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$630.70 / 1 Day
Res Hab-2 Person-NG 4-Elig	$820.15 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$689.49 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-1 Person-Inelig	$99.10 / 1 Day
Res Hab-Lic-2 Person-Inelig	$54.05 / 1 Day
Res Hab-Lic-3 Person-Inelig	$38.74 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$30.10 / 1 Day
Respite-Base Out-of-Home 24 Hours (Basic)-Day	Not Set
Respite-Base Out-of-Home 24 Hours (Level 2)-Day	Not Set
Respite-Lic-Day-2 person-NG 3	$696.86 / 1 Day
Respite-Lic-Day-2 person-NG 4	$755.65 / 1 Day
Respite-Lic-Day-2 person-NG 4-Emergency	$755.65 / 1 Day
Respite-Lic-Day-2 person-NG1	$474.70 / 1 Day
Respite-Lic-Day-3 person-NG 2	$395.52 / 1 Day
Respite-Lic-Day-3 person-NG 3	$495.21 / 1 Day
Respite-Lic-Day-4 person-NG 1-Emergency	$278.56 / 1 Day
Respite-Lic-Day-4 person-NG 2	$314.71 / 1 Day
Respite-Lic-Day-4 person-NG 2-Emergency	$314.71 / 1 Day
Respite-Lic-Day-4 person-NG 4	$422.61 / 1 Day
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd)	$12.30 / 15 min.
Respite-Unlic-15-min(Level 3, 1:1)In-Home	$7.95 / 15 min.
Respite-Unlic-Day (Basic 1:4) Out-of-Home	$90.59 / 1 Day
Respite-Unlic-Day (Level 2, 1:2) In-Home	$176.17 / 1 Day
Respite-Unlic-Day (Level 3, 1:1 Enh) In-Home	$491.89 / 1 Day
Respite-Unlic-Day (Level 3, 1:1) In-Home	$317.80 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.
Support (Medical Environment) (Level 3)-15 Mins	Not Set
Supported Emplymnt-Career Assessment	$17.91 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$17.91 / 15 min.
Supported Emplymnt-Job Support - 1:1	$17.91 / 15 min.
Supported Emplymnt-Job Support-1:2	$10.72 / 15 min.
Supported Living-1 Person-NG1	$151.12 / 1 Day
Transportation(Zone 1)-Trip	$33.83 / Trip
Transportation(Zone 2)-Trip	$60.91 / Trip
Transportation(Zone 3)-Trip	$69.19 / Trip

County : Lehigh
\|Service Name / Level	\|Rate

In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-Lic-3 Person-Inelig	$38.74 / 1 Day

County : Northampton
\|Service Name / Level	\|Rate

CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS: Community OnCall/Remote Support	$1.64 / 15 min.
Companion Services (Basic Staff Support)	$3.19 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Life Sharing-1 person-Elig-NG 1 > 30 Hrs	$171.35 / 1 Day
Life Sharing-1 person-Elig-NG 2 > 30 Hrs	$204.29 / 1 Day
Life Sharing-1 person-Elig-NG 3 > 30 Hrs	$279.58 / 1 Day
Life Sharing-1 person-Elig-NG 4 > 30 Hrs	$355.61 / 1 Day
Life Sharing-2 person-Elig-NG 2 > 30 Hrs	$144.84 / 1 Day
Life Sharing-2 person-Elig-NG 3 > 30 Hrs	$197.06 / 1 Day
Needs Exception Allowance (NEA)-Adult Res (6400)	$0.01 - $508.93 / 1 Day
Needs Excptn Allowance (NEA)-Adult Res (6400)-521	$0.01 - $649.64 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-3 Person-Inelig	$38.74 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$30.10 / 1 Day
Respite-Unlic- 15-min (Basic 1:4)	$2.26 / 15 min.
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd)	$12.30 / 15 min.
Respite-Unlic-15-min(Level 1, 1:3) Out-of-Home	$2.98 / 15 min.
Respite-Unlic-15-min(Level 2, 1:2)Out-of-Home	$4.40 / 15 min.
Respite-Unlic-15-min(Level 3, 1:1)Out-of-Home	$7.95 / 15 min.
Respite-Unlic-Day (Basic 1:4) Out-of-Home	$90.59 / 1 Day
Respite-Unlic-Day (Level 1, 1:3) Out-of-Home	$119.11 / 1 Day
Respite-Unlic-Day (Level 2, 1:2) In-Home	$176.17 / 1 Day
Respite-Unlic-Day (Level 2, 1:2) Out-of-Home	$176.17 / 1 Day
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	$317.80 / 1 Day
Supported Emplymnt-Job Finding/Job Development	$17.91 / 15 min.
Supported Emplymnt-Job Support - 1:1	$17.91 / 15 min.
Supported Emplymnt-Job Support-1:2	$10.72 / 15 min.
Transportation(Zone 1)-Trip	$33.83 / Trip
Transportation(Zone 2)-Trip	$60.91 / Trip
Transportation(Zone 3)-Trip	$69.19 / Trip

County : Philadelphia
\|Service Name / Level	\|Rate

Needs Exception Allowance (NEA)-Adult Res (6400)	$0.01 - $508.93 / 1 Day
Needs Excptn Allowance (NEA)-Adult Res (6400)-521	$0.01 - $649.64 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-Lic-3 Person-Inelig	$38.74 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.

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