Healthcare Provider Details

I. General information

NPI: 1720520802
Provider Name (Legal Business Name): OPTIMUM CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N MAIN ST
ANDERSON SC
29621-5525
US

IV. Provider business mailing address

802 N MAIN ST
ANDERSON SC
29621-5525
US

V. Phone/Fax

Practice location:
  • Phone: 864-634-8555
  • Fax:
Mailing address:
  • Phone: 864-634-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: LASHERRIE JOHNSON
Title or Position: ADMINISTRATION
Credential:
Phone: 864-634-8555