Provider Demographics
NPI:1740543735
Name:OPTIMA HOMEHEALTH CARE
Entity type:Organization
Organization Name:OPTIMA HOMEHEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:JIMMY
Authorized Official - Last Name:MOMODU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-293-0900
Mailing Address - Street 1:6350 WESTHAVEN DR STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2731
Mailing Address - Country:US
Mailing Address - Phone:317-293-0900
Mailing Address - Fax:317-293-0901
Practice Address - Street 1:6350 WESTHAVEN DR STE E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2731
Practice Address - Country:US
Practice Address - Phone:317-293-0900
Practice Address - Fax:317-293-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120127531251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health