Provider Demographics
NPI:1154650893
Name:OPTIMAL HEALTH MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:OPTIMAL HEALTH MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-984-7764
Mailing Address - Street 1:PO BOX 890422
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16134 WHITE STAR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-5023
Practice Address - Country:US
Practice Address - Phone:281-984-7764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management