Provider Demographics
NPI:1245744036
Name:OPTIMAL CARE CASE MANAGEMENT LLC
Entity Type:Organization
Organization Name:OPTIMAL CARE CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-470-2663
Mailing Address - Street 1:233 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3611
Mailing Address - Country:US
Mailing Address - Phone:248-470-2663
Mailing Address - Fax:248-706-6124
Practice Address - Street 1:233 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3611
Practice Address - Country:US
Practice Address - Phone:248-470-2663
Practice Address - Fax:248-706-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801341052.Medicaid