Provider Demographics
NPI:1821141417
Name:OPTIMUM BASE SERVICES INC.
Entity Type:Organization
Organization Name:OPTIMUM BASE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:ONYIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-340-7900
Mailing Address - Street 1:10945 ESTATE LN STE E325
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2317
Mailing Address - Country:US
Mailing Address - Phone:214-354-7703
Mailing Address - Fax:
Practice Address - Street 1:8613 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-4842
Practice Address - Country:US
Practice Address - Phone:214-340-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX743177Medicare PIN