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General NPI Number Information
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NPI Number | 1922589654
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Entity Type | Organization
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Legal Business Name | OPTIMUM RESOURCE SERVICES, LLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 711 HARRY S. TRUMAN DR UNIT #105
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City | LARGO
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State | MD
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Zip | 20774
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Country | US
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Telephone | 202-740-0252
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Fax |
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Provider Business Mailing Address
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Address Line | 711 HARRY S. TRUMAN DR UNIT #105
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City | LARGO
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State | MD
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Zip | 20774
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Country | US
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Telephone | 202-740-0252
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. GREGORY BELL
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Credential | BS PSYCHOLOGY
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Telephone | 202-740-0252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | MD
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