MEDICARE: OPTIMAL LIVING HEALTH CARE

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1679389043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL LIVING HEALTH CARE

Provider Business Mailing Address
First Line	:	1860 DIGGS AVE
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36617-3311
Country	:	US
Telephone Number	:	770-203-5095
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 LIBERTY HILL DR
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401-2680
Country	:	US
Telephone Number	:	770-203-5095
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAJUANA JAMES JACKSON
Credential	:	LPN
Telephone Number	:	770-203-5095

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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Directions to “OPTIMAL LIVING HEALTH CARE ” Practice Location

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