Healthcare Provider Details

I. General information

NPI: 1710554324
Provider Name (Legal Business Name): OPTIMUM PERSONAL CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226A E MAIN ST
DILLON SC
29536-3440
US

IV. Provider business mailing address

226A E MAIN ST
DILLON SC
29536-3440
US

V. Phone/Fax

Practice location:
  • Phone: 910-374-4492
  • Fax: 843-487-5058
Mailing address:
  • Phone: 910-374-4492
  • Fax: 843-487-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. APRIL MICHELLE CHAVIS
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 910-347-4492