Provider Demographics
NPI:1558972034
Name:OPTIMUM CARE SYSTEMS LLC
Entity Type:Organization
Organization Name:OPTIMUM CARE SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TEAIRRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-447-1694
Mailing Address - Street 1:20722 BRADFORD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3678
Mailing Address - Country:US
Mailing Address - Phone:816-447-1694
Mailing Address - Fax:
Practice Address - Street 1:4141 SOUTHWEST FWY STE 515
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7364
Practice Address - Country:US
Practice Address - Phone:816-447-1694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNAMedicaid