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General NPI Number Information
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NPI Number | 1376701722
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Entity Type | Organization
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Legal Business Name | COMMUNITY-BASED OPTIONS, INC.
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Dates
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Enumeration Date | 05/31/2008
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Last Update Date | 05/31/2008
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Provider Practice Location Address
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Address Line | 435 W OAK AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2737
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Country | US
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Telephone | 850-215-7688
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Fax | 850-769-2088
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Provider Business Mailing Address
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Address Line | PO BOX 438
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City | PANAMA CITY
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State | FL
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Zip | 32402-0438
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Country | US
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Telephone | 850-215-7688
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Fax | 850-769-2088
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. GLENN FREDERICK LORD JR.
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Credential | M.S.W
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Telephone | 850-249-6195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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