Provider Demographics
NPI:1437471448
Name:OPTIONS FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:OPTIONS FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:920-490-8270
Mailing Address - Street 1:555 COUNTRY CLUB RD
Mailing Address - Street 2:PO BOX 11967
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-4908
Mailing Address - Country:US
Mailing Address - Phone:920-490-8270
Mailing Address - Fax:920-490-0700
Practice Address - Street 1:555 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-4908
Practice Address - Country:US
Practice Address - Phone:920-490-8270
Practice Address - Fax:920-490-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100003331253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100003331Medicaid