Provider Demographics
NPI:1750427514
Name:OPTIHEALTH, INC.
Entity type:Organization
Organization Name:OPTIHEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-875-1900
Mailing Address - Street 1:4620 JEFFERSON LN NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2120
Mailing Address - Country:US
Mailing Address - Phone:505-875-1900
Mailing Address - Fax:505-837-2765
Practice Address - Street 1:4620 JEFFERSON LN NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2120
Practice Address - Country:US
Practice Address - Phone:505-875-1900
Practice Address - Fax:505-837-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDEPARTMENT OF HEALTH320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities