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General NPI Number Information
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NPI Number | 1538390141
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Entity Type | Organization
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Legal Business Name | OPTIONS RESIDENTIAL, INC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 2105 W BURNSVILLE PKWY
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City | BURNSVILLE
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State | MN
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Zip | 55337-4237
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Country | US
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Telephone | 952-564-3030
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Fax | 952-564-3038
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Provider Business Mailing Address
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Address Line | 2105 W BURNSVILLE PKWY
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City | BURNSVILLE
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State | MN
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Zip | 55337-4237
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Country | US
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Telephone | 952-564-3030
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Fax | 952-564-3038
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRIAN P SAMMON
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Credential | LMFT
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Telephone | 612-226-7120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 1049866-1-ADC
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License Number State | MN
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