MEDICARE: OPTIMAL HEALTH CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1235676826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3310 WARRENSVILLE CENTER RD
Second Line	:	SUITE 306
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-3711
Country	:	US
Telephone Number	:	216-894-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 WARRENSVILLE CENTER RD
Second Line	:	SUITE 306
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-3711
Country	:	US
Telephone Number	:	216-894-5475
Fax Number	:

Authorized Official
Title or Position	:	AGENCY ADMINISTRATOR
Name	:	MR. DIONDRE JERIEL WARREN
Credential	:
Telephone Number	:	216-894-5475

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

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