Healthcare Provider Details

I. General information

NPI: 1326993122
Provider Name (Legal Business Name): OPTIMUM VICTORY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11706 STONE MILL RD
CINCINNATI OH
45251-4126
US

IV. Provider business mailing address

1255 KEMPER MEADOW DR STE 200
CINCINNATI OH
45240-1633
US

V. Phone/Fax

Practice location:
  • Phone: 513-252-7792
  • Fax:
Mailing address:
  • Phone: 513-252-7792
  • Fax: 513-444-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HOLLEY GRUENWALD
Title or Position: OWNER
Credential:
Phone: 513-252-7792