Provider Demographics
NPI:1518196492
Name:OPTIMUM BEHAVIORAL HEALTH CARE
Entity Type:Organization
Organization Name:OPTIMUM BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-587-4112
Mailing Address - Street 1:1109 E MEMORIAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3919
Mailing Address - Country:US
Mailing Address - Phone:252-332-2013
Mailing Address - Fax:
Practice Address - Street 1:1109 E MEMORIAL DR STE 2
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3919
Practice Address - Country:US
Practice Address - Phone:252-332-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health