Provider Demographics
NPI:1396925103
Name:OPTIMA HOME HEALTH SERVICES
Entity type:Organization
Organization Name:OPTIMA HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-682-7555
Mailing Address - Street 1:1935 CHICAGO AVE UNIT C1
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2368
Mailing Address - Country:US
Mailing Address - Phone:951-682-7555
Mailing Address - Fax:951-682-7544
Practice Address - Street 1:1935 CHICAGO AVE UNIT C1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2368
Practice Address - Country:US
Practice Address - Phone:951-682-7555
Practice Address - Fax:951-682-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396925103Medicaid
CA059221Medicare PIN