Provider Demographics
NPI:1619940012
Name:OPTIMUM KIDS LTD
Entity Type:Organization
Organization Name:OPTIMUM KIDS LTD
Other - Org Name:MISSION AUTISM CENTER & KIDS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:956-583-1527
Mailing Address - Street 1:508 W GRIFFIN PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2223
Mailing Address - Country:US
Mailing Address - Phone:956-583-1527
Mailing Address - Fax:
Practice Address - Street 1:508 W GRIFFIN PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2223
Practice Address - Country:US
Practice Address - Phone:956-583-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
TX550830000261QR0401X
TX650620000261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157077201Medicaid
TX454828Medicare ID - Type UnspecifiedPROVIDER NUMBER