Provider Demographics
NPI:1417424391
Name:OPTIMAL WELLNESS 365 LLC
Entity Type:Organization
Organization Name:OPTIMAL WELLNESS 365 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:662-902-0173
Mailing Address - Street 1:4375 HIGHWAY 51 N APT 25-201
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-8720
Mailing Address - Country:US
Mailing Address - Phone:662-902-0173
Mailing Address - Fax:
Practice Address - Street 1:4375 HIGHWAY 51 N APT 25-201
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-8720
Practice Address - Country:US
Practice Address - Phone:662-902-0173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care