Provider Demographics
NPI:1760547111
Name:MEDICAL CARE OPTIONS
Entity Type:Organization
Organization Name:MEDICAL CARE OPTIONS
Other - Org Name:INNOVATIVE HOME HEALTH AND STAFFING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-977-0895
Mailing Address - Street 1:100 S SPRING AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-3657
Mailing Address - Country:US
Mailing Address - Phone:605-977-0895
Mailing Address - Fax:605-977-0897
Practice Address - Street 1:100 S SPRING AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-3657
Practice Address - Country:US
Practice Address - Phone:605-977-0895
Practice Address - Fax:605-977-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9535142Medicaid
SD5195062OtherADLS PROGRAM
SD9550184Medicare ID - Type UnspecifiedMEDICAID WAIVER