1588710917 NPI number — OPTIONS FOR BETTER LIVING, 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 1588710917 NPI number — OPTIONS FOR BETTER LIVING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIONS FOR BETTER LIVING, 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:
1588710917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E WINSLOW RD
Provider Second Line Business Mailing Address:
P.O. BOX 1732
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47401-8657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-332-9615
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPENCER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47460-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-829-1833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RINNE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
GWYNN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
812-332-9615

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  2507B0003JN06 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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