Healthcare Provider Details

I. General information

NPI: 1063028660
Provider Name (Legal Business Name): OPTIMAL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 NATIONAL HWY
THOMASVILLE NC
27360-2312
US

IV. Provider business mailing address

1052 NATIONAL HWY
THOMASVILLE NC
27360-2312
US

V. Phone/Fax

Practice location:
  • Phone: 336-754-1470
  • Fax: 336-652-3155
Mailing address:
  • Phone: 336-754-1470
  • Fax: 336-652-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TAHESIA MCKNIGHT
Title or Position: CEO
Credential:
Phone: 336-754-1470