Provider Demographics
NPI:1083158406
Name:OPTIMUM PERSONAL CARE & SITTERS
Entity Type:Organization
Organization Name:OPTIMUM PERSONAL CARE & SITTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:601-259-4602
Mailing Address - Street 1:PO BOX 83040
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39283-3040
Mailing Address - Country:US
Mailing Address - Phone:601-259-4602
Mailing Address - Fax:769-572-5714
Practice Address - Street 1:4520 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5307
Practice Address - Country:US
Practice Address - Phone:601-259-4602
Practice Address - Fax:769-572-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health