Healthcare Provider Details

I. General information

NPI: 1841028818
Provider Name (Legal Business Name): OPTIMAL SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 MORRIS ST NE APT 2702
ALBUQUERQUE NM
87111-7736
US

IV. Provider business mailing address

11024 MONTGOMERY BLVD NE # 101
ALBUQUERQUE NM
87111-3962
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-0661
  • Fax: 505-581-3286
Mailing address:
  • Phone: 505-750-0661
  • Fax: 505-581-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE UNDERWOOD
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 505-750-0661