Provider Demographics
NPI:1871841403
Name:OPTIMUM ASSISTED LIVING, LLC.
Entity Type:Organization
Organization Name:OPTIMUM ASSISTED LIVING, LLC.
Other - Org Name:MD SENIOR CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-797-1283
Mailing Address - Street 1:1104 OLD CHARLOTTE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187
Mailing Address - Country:US
Mailing Address - Phone:615-797-1283
Mailing Address - Fax:615-797-1284
Practice Address - Street 1:1104 OLD CHARLOTTE RD
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187
Practice Address - Country:US
Practice Address - Phone:615-797-1283
Practice Address - Fax:615-797-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000233310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility