Provider Demographics
NPI:1255072708
Name:OPTIMAL HEALTH & BALANCE LLC
Entity type:Organization
Organization Name:OPTIMAL HEALTH & BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FORSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:262-358-2954
Mailing Address - Street 1:6925 184TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:WI
Mailing Address - Zip Code:53104-9747
Mailing Address - Country:US
Mailing Address - Phone:262-358-2954
Mailing Address - Fax:
Practice Address - Street 1:6925 184TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:WI
Practice Address - Zip Code:53104-9747
Practice Address - Country:US
Practice Address - Phone:262-358-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)