Healthcare Provider Details

I. General information

NPI: 1558785253
Provider Name (Legal Business Name): OPTUMUMHEALTHOUTCOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2014
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 N ORANGE BLOSSOM TRL SUITE 108
ORLANDO FL
32810-1042
US

IV. Provider business mailing address

4531 ARCH ST
ORLANDO FL
32808-7805
US

V. Phone/Fax

Practice location:
  • Phone: 407-394-7181
  • Fax: 810-222-6666
Mailing address:
  • Phone: 407-394-7181
  • Fax: 810-222-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY EDWARDS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-394-7181