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General NPI Number Information
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NPI Number | 1144593229
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Entity Type | Organization
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Legal Business Name | OPTIMAL HOME CARE, LLC
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Dates
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Enumeration Date | 02/20/2012
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 15282 W BROOKSIDE LN SUITE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-2447
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Country | US
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Telephone | 602-466-7570
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Fax | 602-466-7507
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Provider Business Mailing Address
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Address Line | 15282 W BROOKSIDE LN SUITE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-2447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARRELL DIERKS
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Credential | RN, MBA
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Telephone | 602-466-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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