Provider Demographics
NPI:1326281916
Name:OPTIMAL CARE RESIDENTIAL SERVICE AGENCY,LLC
Entity Type:Organization
Organization Name:OPTIMAL CARE RESIDENTIAL SERVICE AGENCY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-483-2075
Mailing Address - Street 1:4604 STEETON CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-6207
Mailing Address - Country:US
Mailing Address - Phone:757-483-2075
Mailing Address - Fax:757-369-7004
Practice Address - Street 1:4604 STEETON CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-6207
Practice Address - Country:US
Practice Address - Phone:757-483-2075
Practice Address - Fax:757-369-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care