Provider Demographics
NPI:1568946663
Name:OPTUMA INC
Entity Type:Organization
Organization Name:OPTUMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-282-9151
Mailing Address - Street 1:2021 E HENNEPIN AVE STE 193
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1773
Mailing Address - Country:US
Mailing Address - Phone:612-282-9151
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE 193
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1773
Practice Address - Country:US
Practice Address - Phone:612-282-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based