Provider Demographics
NPI:1770024416
Name:OPTIMUM PERSONAL CARE & SITTERS, INC.
Entity type:Organization
Organization Name:OPTIMUM PERSONAL CARE & SITTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-259-4602
Mailing Address - Street 1:4500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5307
Practice Address - Country:US
Practice Address - Phone:601-259-4602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08559576Medicaid