Provider Demographics
NPI:1679389043
Name:OPTIMAL LIVING HEALTH CARE
Entity type:Organization
Organization Name:OPTIMAL LIVING HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAJUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:770-203-5095
Mailing Address - Street 1:1860 DIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-3311
Mailing Address - Country:US
Mailing Address - Phone:770-203-5095
Mailing Address - Fax:
Practice Address - Street 1:516 LIBERTY HILL DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-2680
Practice Address - Country:US
Practice Address - Phone:770-203-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide