MEDICARE: OPTIMAL HEALTH & BALANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1255072708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL HEALTH & BALANCE LLC

Provider Business Mailing Address
First Line	:	6123 GREEN BAY RD STE 120
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-2927
Country	:	US
Telephone Number	:	262-358-2954
Fax Number	:

Provider Business Practice Location Address
First Line	:	6123 GREEN BAY RD STE 120
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-2927
Country	:	US
Telephone Number	:	262-358-2954
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. IMELDA N FORSBERG
Credential	:	PMHNP-C
Telephone Number	:	262-358-2954

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	06/03/2026

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