Healthcare Provider Details

I. General information

NPI: 1902857170
Provider Name (Legal Business Name): OPTIONAL HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DUNLAP CT
SAVOY IL
61874-9501
US

IV. Provider business mailing address

7 DUNLAP CT
SAVOY IL
61874-9501
US

V. Phone/Fax

Practice location:
  • Phone: 217-359-5372
  • Fax: 217-359-5373
Mailing address:
  • Phone: 217-359-5372
  • Fax: 217-359-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010381
License Number StateIL

VIII. Authorized Official

Name: MRS. SANDRA LYNN KLINE
Title or Position: VICE-PRESIDENT
Credential: RN
Phone: 217-359-5372