Healthcare Provider Details

I. General information

NPI: 1740069632
Provider Name (Legal Business Name): OPTIMUM HOME CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 SASSACUS LN
APEX NC
27523-3836
US

IV. Provider business mailing address

2007 SASSACUS LN
APEX NC
27523-3836
US

V. Phone/Fax

Practice location:
  • Phone: 919-548-1181
  • Fax:
Mailing address:
  • Phone: 919-548-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LATORRIE SUZETTE CARTER
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 919-548-1181