NPIMap

Organization Active NPI

Options Residential, Inc

  • Foster Care Agency
  • Eagan, MN
National Provider Identifier
1063746386
Registry record updated Sep 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
License
1037818-1-AFC Issued in MN
Legal business name
OPTIONS RESIDENTIAL, INC
Practice address
3958 Beryl Rd
Eagan, MN 55122-1615
Phone
(651) 405-6948
Fax
(651) 454-3099
NPI assigned
Sep 21, 2009
Last updated
Sep 21, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
OPTIONS RESIDENTIAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brian P Sammon, LADC, LMFT
Title
President
Phone
(612) 226-7120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foster Care Agency 253J00000X 1037818-1-AFC MN Primary

Addresses

Primary practice location

3958 Beryl Rd
Eagan, MN 55122-1615

Mailing address

2105 W Burnsville Pkwy
Burnsville, MN 55337-4237
Phone (952) 564-3030

Other identifiers 2

IdentifierTypeStateIssuer
A630173801MedicaidMN
138003OtherMNUCARE

Other names 1

  • Woodhaven House Other name

National Provider Directory

National Provider Directory
Tax ID family
Options Residential Inc18 organizations share this tax ID, including this one
Part of
Options Residential Inc

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253491200000",
    "number": "1063746386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 W BURNSVILLE PKWY",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374237",
            "telephone_number": "952-564-3030",
            "fax_number": "952-564-3038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3958 BERYL RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221615",
            "telephone_number": "651-405-6948",
            "fax_number": "651-454-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIONS RESIDENTIAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTIONS RESIDENTIAL, INC",
        "enumeration_date": "2009-09-21",
        "last_updated": "2009-09-21",
        "status": "A",
        "authorized_official_last_name": "SAMMON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-226-7120",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LADC, LMFT"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "MN",
            "license": "1037818-1-AFC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A630173801",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "138003",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodhaven House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.