Provider Demographics
NPI:1356651012
Name:SENIOR OPTIONS GROUP
Entity Type:Organization
Organization Name:SENIOR OPTIONS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:937-299-5555
Mailing Address - Street 1:3571 TOWERWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503
Mailing Address - Country:US
Mailing Address - Phone:937-299-5555
Mailing Address - Fax:937-299-2432
Practice Address - Street 1:4025 MARSHALL ROAD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440
Practice Address - Country:US
Practice Address - Phone:937-299-5555
Practice Address - Fax:937-299-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health