Provider Demographics
NPI:1194945378
Name:OPTIONS TREATMENT PROGRAMS, INC
Entity type:Organization
Organization Name:OPTIONS TREATMENT PROGRAMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-735-9010
Mailing Address - Street 1:1000 N LYNNDALE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3057
Mailing Address - Country:US
Mailing Address - Phone:920-735-9010
Mailing Address - Fax:920-735-9050
Practice Address - Street 1:1000 N LYNNDALE DR
Practice Address - Street 2:SUITE C
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3057
Practice Address - Country:US
Practice Address - Phone:920-735-9010
Practice Address - Fax:920-735-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42235900Medicaid