Provider Demographics
NPI:1720409311
Name:SELF-DIRECTED OPTIONS, LLC
Entity Type:Organization
Organization Name:SELF-DIRECTED OPTIONS, LLC
Other - Org Name:AAA PATICIPANT DIRECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-450-5974
Mailing Address - Street 1:4300 SILVER AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2748
Mailing Address - Country:US
Mailing Address - Phone:505-508-5524
Mailing Address - Fax:888-334-7353
Practice Address - Street 1:4300 SILVER AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2748
Practice Address - Country:US
Practice Address - Phone:505-508-5524
Practice Address - Fax:888-334-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68289758Medicaid