Healthcare Provider Details

I. General information

NPI: 1477315737
Provider Name (Legal Business Name): OPTIMAL OUTCOMES FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 OLD RODGERS RD STE B
BRISTOL PA
19007-3015
US

IV. Provider business mailing address

315 OLD RODGERS RD STE B
BRISTOL PA
19007-3015
US

V. Phone/Fax

Practice location:
  • Phone: 267-320-5784
  • Fax:
Mailing address:
  • Phone: 267-320-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRADLYN BLANTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 215-554-7066