MEDICARE: OPTIONS RESIDENTIAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	1049866-1-ADC	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	162386	OTHER	MN	UCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538390141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIONS RESIDENTIAL, INC

Provider Business Mailing Address
First Line	:	2105 W BURNSVILLE PKWY
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4237
Country	:	US
Telephone Number	:	952-564-3030
Fax Number	:	952-564-3038

Provider Business Practice Location Address
First Line	:	2105 W BURNSVILLE PKWY
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4237
Country	:	US
Telephone Number	:	952-564-3030
Fax Number	:	952-564-3038

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRIAN P SAMMON
Credential	:	LMFT
Telephone Number	:	612-226-7120

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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2105 W BURNSVILLE PKWY
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1992029151 — MS. DIANE MARIE GREIG RN, MJN
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Practice Location Address:

2709 HIGHLAND DR
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13710 WASHBURN AVE S
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1538493457 — OPTIONS RESIDENTIAL INC
Practice Location Address:

3417 W 132ND ST
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Directions to “OPTIONS RESIDENTIAL, INC ” Practice Location

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