MEDICARE: OPTIMUM PROFESSIONALS HOME HEALTH CARE INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1396861159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM PROFESSIONALS HOME HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	3520 S MORGAN ST FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1524
Country	:	US
Telephone Number	:	773-847-3220
Fax Number	:	773-847-3828

Provider Business Practice Location Address
First Line	:	3520 S MORGAN ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-5655
Country	:	US
Telephone Number	:	773-847-3220
Fax Number	:	773-847-3828

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LOIDA E RAYA
Credential	:	REGISTERED NURSE
Telephone Number	:	773-847-3220

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	12/23/2011

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