Healthcare Provider Details

I. General information

NPI: 1780218404
Provider Name (Legal Business Name): OPTIMA HEALTH CARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 2ND AVE N
TWIN FALLS ID
83301-5745
US

IV. Provider business mailing address

3303 ASPEN RIDGE CIR
KIMBERLY ID
83341-5511
US

V. Phone/Fax

Practice location:
  • Phone: 208-421-8358
  • Fax:
Mailing address:
  • Phone: 208-421-8358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE POTTER
Title or Position: OWNER
Credential:
Phone: 208-421-8358