Provider Demographics
NPI:1376701722
Name:COMMUNITY-BASED OPTIONS, INC.
Entity Type:Organization
Organization Name:COMMUNITY-BASED OPTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:LORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW
Authorized Official - Phone:850-249-6195
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0438
Mailing Address - Country:US
Mailing Address - Phone:850-215-7688
Mailing Address - Fax:850-769-2088
Practice Address - Street 1:435 W OAK AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2737
Practice Address - Country:US
Practice Address - Phone:850-215-7688
Practice Address - Fax:850-769-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686106796Medicaid