Provider Demographics
NPI:1083113344
Name:OPTIMAL HOMECARE SERVICES, INCORPORATED
Entity Type:Organization
Organization Name:OPTIMAL HOMECARE SERVICES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OJENGBEDE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:708-265-5855
Mailing Address - Street 1:282 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2098
Mailing Address - Country:US
Mailing Address - Phone:708-265-5855
Mailing Address - Fax:708-265-5845
Practice Address - Street 1:282 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2098
Practice Address - Country:US
Practice Address - Phone:708-265-5855
Practice Address - Fax:708-265-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1012002OtherIDPH LICENSE