Healthcare Provider Details

I. General information

NPI: 1487533014
Provider Name (Legal Business Name): OPTIMA HOMEHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13875 CHESTNUT DR APT 212
EDEN PRAIRIE MN
55344-6750
US

IV. Provider business mailing address

13875 CHESTNUT DR APT 212
EDEN PRAIRIE MN
55344-6750
US

V. Phone/Fax

Practice location:
  • Phone: 612-597-1357
  • Fax:
Mailing address:
  • Phone: 612-597-1357
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED AHMED
Title or Position: OWNER
Credential:
Phone: 612-597-1357