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General NPI Number Information
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NPI Number | 1437471448
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Entity Type | Organization
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Legal Business Name | OPTIONS FOR INDEPENDENT LIVING
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 555 COUNTRY CLUB RD
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City | GREEN BAY
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State | WI
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Zip | 54313-4908
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Country | US
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Telephone | 920-490-8270
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Fax | 920-490-0700
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Provider Business Mailing Address
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Address Line | 555 COUNTRY CLUB RD PO BOX 11967
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City | GREEN BAY
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State | WI
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Zip | 54313-4908
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Country | US
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Telephone | 920-490-8270
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Fax | 920-490-0700
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | MS. KATHRYN C BARRY
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Credential | M.A.
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Telephone | 920-490-8270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 100003331
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License Number State | WI
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