Provider Demographics
NPI:1275140659
Name:OPTIMAL HEALTH RECOVERY AND WEIGHT LOSS LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH RECOVERY AND WEIGHT LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-398-5232
Mailing Address - Street 1:250 FOXGLOVE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9770
Mailing Address - Country:US
Mailing Address - Phone:859-398-8252
Mailing Address - Fax:
Practice Address - Street 1:250 FOXGLOVE DR STE 3
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9770
Practice Address - Country:US
Practice Address - Phone:859-398-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty