Provider Demographics
NPI:1891418083
Name:OPTIMAL HOME CARE AGENCY COMPANY
Entity Type:Organization
Organization Name:OPTIMAL HOME CARE AGENCY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MBUGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-458-1713
Mailing Address - Street 1:2850 SW CEDAR HILLS BLVD # 142
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4542 NW TUMALO CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2750
Practice Address - Country:US
Practice Address - Phone:503-825-0600
Practice Address - Fax:971-357-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care