Provider Demographics
NPI:1497520407
Name:OPTIMAL COMMUNITY SUPPORT SERVICE ,LLC
Entity Type:Organization
Organization Name:OPTIMAL COMMUNITY SUPPORT SERVICE ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:336-312-2614
Mailing Address - Street 1:1304 CLIFFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4107
Mailing Address - Country:US
Mailing Address - Phone:336-312-2614
Mailing Address - Fax:
Practice Address - Street 1:1304 CLIFFWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4107
Practice Address - Country:US
Practice Address - Phone:336-312-2614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health