Provider Demographics
NPI:1699369223
Name:OPTIMAL HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:OPTIMAL HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:AUDREA
Authorized Official - Middle Name:CAMILEE
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-580-2083
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:CONEJOS
Mailing Address - State:CO
Mailing Address - Zip Code:81129-0036
Mailing Address - Country:US
Mailing Address - Phone:719-580-2083
Mailing Address - Fax:
Practice Address - Street 1:409 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANTONITO
Practice Address - State:CO
Practice Address - Zip Code:81120
Practice Address - Country:US
Practice Address - Phone:719-580-2083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty