Provider Demographics
NPI:1063987113
Name:OPTIONS WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:OPTIONS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP-C
Authorized Official - Phone:256-978-5740
Mailing Address - Street 1:1005 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2401
Mailing Address - Country:US
Mailing Address - Phone:256-978-5740
Mailing Address - Fax:256-978-5774
Practice Address - Street 1:1005 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2401
Practice Address - Country:US
Practice Address - Phone:256-978-5740
Practice Address - Fax:256-978-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL214361Medicaid