Provider Demographics
NPI:1346605599
Name:OPTIMUM HEALTH GROUP INC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH GROUP INC
Other - Org Name:WARD CHIROPRACTIC AND REHABILITATION CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:YN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-225-9000
Mailing Address - Street 1:2323 PENNSYLVANIA AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1332
Mailing Address - Country:US
Mailing Address - Phone:302-225-9000
Mailing Address - Fax:302-225-9005
Practice Address - Street 1:2323 PENNSYLVANIA AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:302-225-9000
Practice Address - Fax:302-225-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000477111N00000X
DEF11000477111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250026551Medicaid