Provider Demographics
NPI:1609261957
Name:OPTIMUM OF NORTH CAROLINA INC
Entity Type:Organization
Organization Name:OPTIMUM OF NORTH CAROLINA INC
Other - Org Name:OPTIMUM HOME CARE OF NORTH CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINICIPAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-704-9031
Mailing Address - Street 1:3437 PONDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-2111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3437 PONDRIDGE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2111
Practice Address - Country:US
Practice Address - Phone:704-975-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health