Provider Demographics
NPI:1780868059
Name:OPTION 1 NUTRITION SOLUTIONS, CA, INC
Entity Type:Organization
Organization Name:OPTION 1 NUTRITION SOLUTIONS, CA, INC
Other - Org Name:OPTION 1 HEALTHCARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:866-883-1188
Mailing Address - Street 1:2460 EAST GERMANN ROAD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286
Mailing Address - Country:US
Mailing Address - Phone:480-883-1188
Mailing Address - Fax:480-883-1193
Practice Address - Street 1:3065 RESEARCH DR.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-233-7332
Practice Address - Fax:510-758-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780868059Medicaid
CA6114060001Medicare NSC