Provider Demographics
NPI:1912715483
Name:OPTIMUS HOME HEALTH CARE
Entity type:Organization
Organization Name:OPTIMUS HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERDAWIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BALCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-928-0591
Mailing Address - Street 1:3976 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1735
Mailing Address - Country:US
Mailing Address - Phone:703-928-0591
Mailing Address - Fax:
Practice Address - Street 1:3976 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1735
Practice Address - Country:US
Practice Address - Phone:703-928-0591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health