Provider Demographics
NPI:1467145318
Name:OPTIMUM HOME CARE INC.
Entity Type:Organization
Organization Name:OPTIMUM HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:KEATON
Authorized Official - Middle Name:C
Authorized Official - Last Name:OXENDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-734-3818
Mailing Address - Street 1:PO BOX 2486
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2486
Mailing Address - Country:US
Mailing Address - Phone:910-734-3818
Mailing Address - Fax:
Practice Address - Street 1:75 NANCY LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9217
Practice Address - Country:US
Practice Address - Phone:910-734-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care