Provider Demographics
NPI:1184898470
Name:OPTIMAE LIFESERVICES,INC.
Entity type:Organization
Organization Name:OPTIMAE LIFESERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTEK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:641-472-1684
Mailing Address - Street 1:301 W BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3242
Mailing Address - Country:US
Mailing Address - Phone:641-472-1684
Mailing Address - Fax:641-472-4609
Practice Address - Street 1:3500 HARMONY CT
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5700
Practice Address - Country:US
Practice Address - Phone:563-263-5585
Practice Address - Fax:563-263-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IACMHC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA600482882OtherIOWA PLAN MIS SITE