Provider Demographics
NPI:1124235163
Name:HEALTHY OPTIONS PREVENTIVE AND EFFECTIVE TREATMENT
Entity type:Organization
Organization Name:HEALTHY OPTIONS PREVENTIVE AND EFFECTIVE TREATMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-233-1785
Mailing Address - Street 1:116 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66603-3902
Mailing Address - Country:US
Mailing Address - Phone:785-233-1785
Mailing Address - Fax:
Practice Address - Street 1:629 SE QUINCY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3921
Practice Address - Country:US
Practice Address - Phone:785-233-1785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS617324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS375340Medicaid