Provider Demographics
NPI:1568961563
Name:OPTIMUM HOMECARE AND COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:OPTIMUM HOMECARE AND COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KONIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-615-7924
Mailing Address - Street 1:3 POND CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01611-1201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:88 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1957
Practice Address - Country:US
Practice Address - Phone:508-615-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency