Provider Demographics
NPI:1952303380
Name:OPTIMA REHABILITATION SERVICES, LTD.
Entity Type:Organization
Organization Name:OPTIMA REHABILITATION SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-447-7203
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-0833
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:27 ST LAWRENCE DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2572
Practice Address - Country:US
Practice Address - Phone:419-447-7203
Practice Address - Fax:419-447-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2038968Medicaid
OH2038968Medicaid
OH2038968Medicaid