Provider Demographics
NPI:1760650576
Name:GERIATRIC OPTIONS LLC
Entity Type:Organization
Organization Name:GERIATRIC OPTIONS LLC
Other - Org Name:GERIATRIC OPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GERONTOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSG
Authorized Official - Phone:757-240-7928
Mailing Address - Street 1:4410 CLAIBORNE SQUARE STE 334
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-2290
Mailing Address - Country:US
Mailing Address - Phone:757-240-7928
Mailing Address - Fax:
Practice Address - Street 1:4410 CLAIBORNE SQUARE STE 334
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2290
Practice Address - Country:US
Practice Address - Phone:757-240-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA112160305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033398003Medicaid