Healthcare Provider Details

I. General information

NPI: 1144903410
Provider Name (Legal Business Name): OPTIMUM HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 WHITE OAK TRL
STONE MOUNTAIN GA
30088-3007
US

IV. Provider business mailing address

4800 WHITE OAK TRL
STONE MOUNTAIN GA
30088-3007
US

V. Phone/Fax

Practice location:
  • Phone: 678-863-2738
  • Fax: 470-282-0031
Mailing address:
  • Phone: 678-863-2738
  • Fax: 470-282-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: ALLY EMANUEL MDAMU
Title or Position: OWNER
Credential:
Phone: 678-863-2738