1225290935 NPI number — DIVERSE OPTIONS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225290935 NPI number — DIVERSE OPTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVERSE OPTIONS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225290935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
571 FENTON ST
Provider Second Line Business Mailing Address:
P.O. BOX 449
Provider Business Mailing Address City Name:
RIPON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54971-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-748-6387
Provider Business Mailing Address Fax Number:
920-748-6030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
571 FENTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54971-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-748-6387
Provider Business Practice Location Address Fax Number:
920-748-6030
Provider Enumeration Date:
06/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHRAEDER
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
ROY
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
920-748-6387

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)