Provider Demographics
NPI:1053459016
Name:OPITMAL HEATH GROUP LLC
Entity Type:Organization
Organization Name:OPITMAL HEATH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:NMT & LMT
Authorized Official - Phone:401-884-1757
Mailing Address - Street 1:1351 S COUNTY TRL
Mailing Address - Street 2:BLDG. # 3, STE. # 305
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5079
Mailing Address - Country:US
Mailing Address - Phone:401-884-1757
Mailing Address - Fax:401-884-1756
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:BLDG. # 3, STE. # 305
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-884-1757
Practice Address - Fax:401-884-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI28054-9OtherBLUE CROSS