Provider Demographics
NPI:1053143180
Name:OPTIMUM HEALTH CARE PROFESSIONALS
Entity type:Organization
Organization Name:OPTIMUM HEALTH CARE PROFESSIONALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLINON
Authorized Official - Suffix:
Authorized Official - Credentials:DEMETRIA MCCLINON
Authorized Official - Phone:877-840-4406
Mailing Address - Street 1:PO BOX 18014
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-0014
Mailing Address - Country:US
Mailing Address - Phone:877-840-4406
Mailing Address - Fax:
Practice Address - Street 1:2521 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-4239
Practice Address - Country:US
Practice Address - Phone:877-840-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health