Provider Demographics
NPI:1548597479
Name:OPTIMAL HOME HEALTH
Entity Type:Organization
Organization Name:OPTIMAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-578-8516
Mailing Address - Street 1:19720 VENTURA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2622
Mailing Address - Country:US
Mailing Address - Phone:818-578-8516
Mailing Address - Fax:818-578-6255
Practice Address - Street 1:19720 VENTURA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2622
Practice Address - Country:US
Practice Address - Phone:818-578-8516
Practice Address - Fax:818-578-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health