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General NPI Number Information
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NPI Number | 1932915436
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Entity Type | Organization
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Legal Business Name | OPTIVACARE LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 650 MAIN ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5448
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Country | US
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Telephone | 612-598-2673
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 BARRINGTON TER
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City | MINNEAPOLIS
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State | MN
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Zip | 55443-1717
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Country | US
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Telephone | 612-598-2673
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | CAMAAR ABDULKADIR
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Credential |
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Telephone | 612-598-2673
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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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