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General NPI Number Information
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NPI Number | 1730654021
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Entity Type | Organization
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Legal Business Name | OPTIMOM HEALTHCARE LLC
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 10101 HARWIN DR STE 322
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City | HOUSTON
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State | TX
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Zip | 77036-1686
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Country | US
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Telephone | 281-513-0068
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Fax | 281-416-4735
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Provider Business Mailing Address
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Address Line | 6119 KNOLLWEST DR
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City | HOUSTON
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State | TX
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Zip | 77072-1021
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Country | US
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Telephone | 832-672-4903
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | SAMUEL L BANGURA
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Credential | OWNER
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Telephone | 281-905-8277
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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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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #3
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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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