Provider Demographics
NPI:1972320315
Name:OPTMIAL LIVING HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:OPTMIAL LIVING HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:DENEE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-717-3456
Mailing Address - Street 1:818 MARY JO LN
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1731
Mailing Address - Country:US
Mailing Address - Phone:314-717-3456
Mailing Address - Fax:
Practice Address - Street 1:818 MARY JO LN
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1731
Practice Address - Country:US
Practice Address - Phone:314-717-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health