Provider Demographics
NPI:1497831507
Name:OPTION 1 NUTRITION SOLUTIONS LLC
Entity Type:Organization
Organization Name:OPTION 1 NUTRITION SOLUTIONS LLC
Other - Org Name:AVEANNA HEALTHCARE MEDICAL SOLUTIONS - OK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-464-8000
Mailing Address - Street 1:400 INTERSTATE NORTH PKWY SE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5047
Mailing Address - Country:US
Mailing Address - Phone:470-464-8000
Mailing Address - Fax:770-248-8192
Practice Address - Street 1:12101 E 51ST ST STE 106
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-6018
Practice Address - Country:US
Practice Address - Phone:918-252-2000
Practice Address - Fax:918-252-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731347232001OtherBCBS OF OK
OK731347232OtherOTHER PROVIDERS
OK100260990BMedicaid
OK100260990BMedicaid