Provider Demographics
NPI:1386869204
Name:OPTIMUM HEALTHCARE, INC.
Entity type:Organization
Organization Name:OPTIMUM HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-833-7514
Mailing Address - Street 1:1050 E. UNIVERSITY DR.
Mailing Address - Street 2:# 9
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203
Mailing Address - Country:US
Mailing Address - Phone:480-833-7514
Mailing Address - Fax:480-733-2487
Practice Address - Street 1:1050 E. UNIVERSITY DR.
Practice Address - Street 2:# 9
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203
Practice Address - Country:US
Practice Address - Phone:480-833-7514
Practice Address - Fax:480-733-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4804251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ654305Medicaid
AZ262687Medicaid
AZ03D1072913OtherCLIA
AZ03-7401Medicare UPIN