Provider Demographics
NPI:1124268131
Name:OPTIMUM CARE CENTERS, LLC.
Entity type:Organization
Organization Name:OPTIMUM CARE CENTERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:KELECHI
Authorized Official - Last Name:CHIDEBELU-EZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-641-2026
Mailing Address - Street 1:3421 LEE RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5621
Mailing Address - Country:US
Mailing Address - Phone:317-641-2026
Mailing Address - Fax:
Practice Address - Street 1:418 E 30TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3909
Practice Address - Country:US
Practice Address - Phone:317-641-2026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002356A111NR0400X
174200000X, 177F00000X, 2081P2900X, 251B00000X, 251E00000X, 251S00000X, 261Q00000X, 261QR0208X, 261QR1100X, 261QR1300X, 291U00000X, 335G00000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No174200000XOther Service ProvidersMealsGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No335G00000XSuppliersMedical Foods Supplier