Provider Demographics
NPI:1306212154
Name:OPTIMUM CARE & TRAINING
Entity Type:Organization
Organization Name:OPTIMUM CARE & TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-207-0195
Mailing Address - Street 1:2776 ROSEBAY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5846
Mailing Address - Country:US
Mailing Address - Phone:904-207-0195
Mailing Address - Fax:
Practice Address - Street 1:2776 ROSEBAY DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5846
Practice Address - Country:US
Practice Address - Phone:904-207-0195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services