Provider Demographics
NPI:1457656340
Name:OPTIMUM HEALTH FOUNDATION
Entity Type:Organization
Organization Name:OPTIMUM HEALTH FOUNDATION
Other - Org Name:OPTIMUM HEALTH GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:ED
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-455-2030
Mailing Address - Street 1:1800 EVARTS ST NE
Mailing Address - Street 2:1800 EVARTS STREET NE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 EVARTS ST NE
Practice Address - Street 2:1800 EVARTS STREET NE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1311
Practice Address - Country:US
Practice Address - Phone:202-455-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251B00000XAgenciesCase Management