Provider Demographics
NPI:1326464272
Name:OPTIMAL WELLNESS, LLC
Entity Type:Organization
Organization Name:OPTIMAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-861-5256
Mailing Address - Street 1:1812 BALTIMORE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7146
Mailing Address - Country:US
Mailing Address - Phone:410-861-5256
Mailing Address - Fax:410-861-5258
Practice Address - Street 1:1812 BALTIMORE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7146
Practice Address - Country:US
Practice Address - Phone:410-861-5256
Practice Address - Fax:410-861-5258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084575261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service