Provider Demographics
NPI:1457654568
Name:ORIGEN BETTER.LLC
Entity Type:Organization
Organization Name:ORIGEN BETTER.LLC
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHAPLAIN
Authorized Official - Prefix:MS
Authorized Official - First Name:TRALADA
Authorized Official - Middle Name:W
Authorized Official - Last Name:PURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MINISTER
Authorized Official - Phone:330-000-0001
Mailing Address - Street 1:1200 S UNION AVE
Mailing Address - Street 2:NONE
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4021
Mailing Address - Country:US
Mailing Address - Phone:330-000-0001
Mailing Address - Fax:330-000-0003
Practice Address - Street 1:1200 S UNION AVE
Practice Address - Street 2:NONE
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4021
Practice Address - Country:US
Practice Address - Phone:330-000-0001
Practice Address - Fax:330-000-0003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH305R00000X305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1645138Medicaid
OH2863552Medicare PIN