Provider Demographics
NPI:1710453428
Name:OPTIMIZED HOME CARE SERVICES
Entity Type:Organization
Organization Name:OPTIMIZED HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:KENIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-902-2148
Mailing Address - Street 1:631 SW 64TH PKWY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33023-1529
Mailing Address - Country:US
Mailing Address - Phone:134-790-2214
Mailing Address - Fax:
Practice Address - Street 1:631 SW 64TH PKWY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33023-1529
Practice Address - Country:US
Practice Address - Phone:347-902-2148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health