Healthcare Provider Details

I. General information

NPI: 1053143149
Provider Name (Legal Business Name): OPTIMUM CARE CLHF 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BRACEBRIDGE RD
RIVERSIDE CA
92506-6115
US

IV. Provider business mailing address

302 FAIRWAY LN
PLACENTIA CA
92870-4442
US

V. Phone/Fax

Practice location:
  • Phone: 310-994-9181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: NICOLAS OUDINOT
Title or Position: OWNER
Credential:
Phone: 310-994-9181