Provider Demographics
NPI:1346308657
Name:OPTIONS RESIDENTIAL, INC
Entity Type:Organization
Organization Name:OPTIONS RESIDENTIAL, INC
Other - Org Name:LAKEWOOD HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADC
Authorized Official - Phone:612-226-7120
Mailing Address - Street 1:615 WEST TRAVELERS TRAIL
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2877
Mailing Address - Country:US
Mailing Address - Phone:952-564-3006
Mailing Address - Fax:652-217-5677
Practice Address - Street 1:12228 S ROBERT TRL
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-3653
Practice Address - Country:US
Practice Address - Phone:651-423-6776
Practice Address - Fax:651-423-6778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIONS RESIDENTIAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN138003OtherUCARE
MNA630173804Medicaid