Provider Demographics
NPI:1003655291
Name:OPTIMUM CARE HOME LLC
Entity type:Organization
Organization Name:OPTIMUM CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:CHINWENDU
Authorized Official - Middle Name:PEACE
Authorized Official - Last Name:ONWUSOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-269-9972
Mailing Address - Street 1:1620 PEGASUS DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1337
Mailing Address - Country:US
Mailing Address - Phone:469-269-9972
Mailing Address - Fax:
Practice Address - Street 1:1620 PEGASUS DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-1337
Practice Address - Country:US
Practice Address - Phone:469-269-9972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care