Healthcare Provider Details

I. General information

NPI: 1033036637
Provider Name (Legal Business Name): OPTIVIDA CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 POMPANO ST
WAVELAND MS
39576-3136
US

IV. Provider business mailing address

4780 I 55 N STE 100
JACKSON MS
39211-5583
US

V. Phone/Fax

Practice location:
  • Phone: 800-574-6030
  • Fax:
Mailing address:
  • Phone: 800-574-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON M WHAVERS
Title or Position: VP
Credential:
Phone: 800-574-6030