=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396938783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIMUM HOME HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2007
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2720 S RIVER RD STE 202
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-4111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-422-7340
-----------------------------------------------------
Fax | 708-422-7348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2720 S RIVER RD STE 202
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-4111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-422-7340
-----------------------------------------------------
Fax | 708-422-7348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. MARIA L DE VERA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 708-422-7340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010740
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------