Provider Demographics
NPI:1003449893
Name:OPTIMAL HEALTH HOME CARE LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH HOME CARE LLC
Other - Org Name:OPITMAL HEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISELOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDEA-AMOAKO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:817-779-4805
Mailing Address - Street 1:2140 HIGHWAY 157 N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4847
Mailing Address - Country:US
Mailing Address - Phone:817-813-8055
Mailing Address - Fax:817-753-0100
Practice Address - Street 1:2140 HIGHWAY 157 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4847
Practice Address - Country:US
Practice Address - Phone:817-813-8055
Practice Address - Fax:817-753-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019799OtherTEXAS HEALTH AND HUMAN SERVICES COMMISSION