Provider Demographics
NPI:1326201047
Name:OPTIMUM MICHIGAN HOME HEALTHCARE
Entity Type:Organization
Organization Name:OPTIMUM MICHIGAN HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EYAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-855-6255
Mailing Address - Street 1:5600 W MAPLE RD
Mailing Address - Street 2:STE D-406
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3711
Mailing Address - Country:US
Mailing Address - Phone:248-855-6255
Mailing Address - Fax:248-855-6256
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:STE D-406
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3711
Practice Address - Country:US
Practice Address - Phone:248-855-6255
Practice Address - Fax:248-855-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health