Provider Demographics
NPI:1598409088
Name:OPTIMAL LIVING HOME CARE SERVICES
Entity Type:Organization
Organization Name:OPTIMAL LIVING HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANNEH
Authorized Official - Middle Name:JOYOUS
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-997-2898
Mailing Address - Street 1:615 SAINT GEORGE SQUARE CT STE 300
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1368
Mailing Address - Country:US
Mailing Address - Phone:336-778-3316
Mailing Address - Fax:336-778-3301
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT STE 316
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:336-778-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health