Provider Demographics
NPI: | 1528227915 |
---|---|
Name: | OPTIONS RESIDENTIAL INC |
Entity Type: | Organization |
Organization Name: | OPTIONS RESIDENTIAL INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BRIAN |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | SAMMON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT LADC |
Authorized Official - Phone: | 612-226-7120 |
Mailing Address - Street 1: | 2105 W BURNSVILLE PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | BURNSVILLE |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55337-4237 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-564-3030 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2105 W BURNSVILLE PKWY |
Practice Address - Street 2: | |
Practice Address - City: | BURNSVILLE |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55337-4237 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-564-3030 |
Practice Address - Fax: | 952-564-3038 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-02 |
Last Update Date: | 2008-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | 138003 | Other | UCARE |