Provider Demographics
NPI:1306505623
Name:OPTIMUM HEALTH LLC
Entity type:Organization
Organization Name:OPTIMUM HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-870-7572
Mailing Address - Street 1:16113 RAMBLING RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6066
Mailing Address - Country:US
Mailing Address - Phone:770-870-7572
Mailing Address - Fax:
Practice Address - Street 1:16113 RAMBLING RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-6066
Practice Address - Country:US
Practice Address - Phone:177-087-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterologyGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No163WC3500XNursing Service ProvidersRegistered NurseCardiac RehabilitationGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
No163WI0600XNursing Service ProvidersRegistered NurseInfection ControlGroup - Single Specialty
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Single Specialty
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Single Specialty