Healthcare Provider Details

I. General information

NPI: 1831844935
Provider Name (Legal Business Name): OPTIMUM HOME CARE OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 79TH TER N APT 211
ST PETERSBURG FL
33702-4371
US

IV. Provider business mailing address

420 79TH TER N APT 210
ST PETERSBURG FL
33702-4371
US

V. Phone/Fax

Practice location:
  • Phone: 414-704-9031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK SHORTER JR.
Title or Position: MANAGING PARTNER
Credential:
Phone: 414-704-9031