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General NPI Number Information
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NPI Number | 1245804525
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Entity Type | Organization
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Legal Business Name | OPTIMA VITAE, LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 3201 UNIVERSITY DR E STE 160
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City | BRYAN
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State | TX
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Zip | 77802-3480
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Country | US
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Telephone | 210-305-9057
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 UNIVERSITY DR E STE 160
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City | BRYAN
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State | TX
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Zip | 77802-3480
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Country | US
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Telephone | 979-431-4848
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Fax | 979-431-4846
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JENNIFER LEWIS
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Credential | MA, CCC-SLP
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Telephone | 979-431-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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