Provider Demographics
NPI:1649239666
Name:OPTION HEALTH CARE INC
Entity Type:Organization
Organization Name:OPTION HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LICKTEIG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:219-736-5334
Mailing Address - Street 1:9111 BROADWAY
Mailing Address - Street 2:SUITE L
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8122
Mailing Address - Country:US
Mailing Address - Phone:219-736-5334
Mailing Address - Fax:219-736-5335
Practice Address - Street 1:9111 BROADWAY
Practice Address - Street 2:SUITE L
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8122
Practice Address - Country:US
Practice Address - Phone:219-736-5334
Practice Address - Fax:219-736-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-008882-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200034260Medicaid
IN200034260Medicaid