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General NPI Number Information
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NPI Number | 1770024416
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Entity Type | Organization
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Legal Business Name | OPTIMUM PERSONAL CARE & SITTERS, INC.
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 4500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39206-5307
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Country | US
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Telephone | 601-259-4602
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39206-5307
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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 | EXECUTIVE DIRECTOR
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Name | MR. CARNELL KITCHENS
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Credential |
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Telephone | 601-259-4602
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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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