Organization
OPTIMUS HEALTH CARE INC
Active
Other names
Ralphola Taylor Community Center
Organization subpart
No
Provider details
NPI number
Authorized official
LUDWIG SPINELLI (CHIEF EXECUTIVE OFFICER)
(203) 696-3260
Entity
Organization
Contact information
Practice address
790 CENTRAL AVE, BRIDGEPORT, CT 06607-1705
(203) 332-4567
(203) 332-0376
Mailing address
982 E MAIN ST, BRIDGEPORT, CT 06608-1913
(203) 696-3260
(203) 332-0376
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
0200
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004234788
—
CT
01
—
C00383
MEDICARE PART B
CT
Enumeration date
12/30/2011
Last updated
12/30/2011
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