Provider Demographics
NPI:1982353314
Name:OPTIMAL HOME HEALTH LLC
Entity Type:Organization
Organization Name:OPTIMAL HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUCKEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-321-2430
Mailing Address - Street 1:981 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1425
Mailing Address - Country:US
Mailing Address - Phone:850-791-6700
Mailing Address - Fax:
Practice Address - Street 1:981 N MILL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1425
Practice Address - Country:US
Practice Address - Phone:850-791-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care