=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538583398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIONS FOR SENIORS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2014
-----------------------------------------------------
Last Update Date | 02/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 S 10TH ST
-----------------------------------------------------
City | HAINES CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33844-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-422-3567
-----------------------------------------------------
Fax | 863-422-2626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 S 10TH ST
-----------------------------------------------------
City | HAINES CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33844-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-422-3567
-----------------------------------------------------
Fax | 863-422-2626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | BROOKE SCHAFER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-325-6060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10407
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------