=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063285575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETTER OPTION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2023
-----------------------------------------------------
Last Update Date | 11/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3055 OLD HIGHWAY 8 STE 307
-----------------------------------------------------
City | ST ANTHONY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55418-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-481-9857
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1728 CLEAR AVE
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55106-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-481-9857
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BONSA YUNUS MOHAMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-481-9857
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------