Healthcare Provider Details

I. General information

NPI: 1285301481
Provider Name (Legal Business Name): OPTION 1 NUTRITION SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 INLAND EMPIRE BLVD STE 280
ONTARIO CA
91764-5557
US

IV. Provider business mailing address

400 INTERSTATE NORTH PKWY SE STE 1600
ATLANTA GA
30339-5047
US

V. Phone/Fax

Practice location:
  • Phone: 480-883-1188
  • Fax: 866-453-3332
Mailing address:
  • Phone: 470-464-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SHANNON DRAKE
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 470-464-8000