- Enrollment id
- O20100805000410
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1669792362
- Multiple npi flag
- N
- Ccn
- 368346
- Associate id
- 9133252596
- Organization name
- OPTIMA HOME HEALTH SERVICES LLC
- Incorporation date
- 2010-05-25
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5979 EAST LIVINGSTON AVE
- Address line 2
- SUITE 107
- City
- COLUMBUS
- State
- OH
- Zip code
- 432322942