Provider Demographics
NPI:1174002174
Name:OPTIMAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ENWOROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-266-0362
Mailing Address - Street 1:730 VALLA CRUCIS LN
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7059
Mailing Address - Country:US
Mailing Address - Phone:770-470-2660
Mailing Address - Fax:
Practice Address - Street 1:730 VALLA CRUCIS LN
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7059
Practice Address - Country:US
Practice Address - Phone:770-470-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067R1509251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health