Healthcare Provider Details

I. General information

NPI: 1659135259
Provider Name (Legal Business Name): OPTIMUM CARE IE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2697 LYON AVE
RIVERSIDE CA
92503-5807
US

IV. Provider business mailing address

2697 LYON AVE
RIVERSIDE CA
92503-5807
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