Organization
OPTIMUM CARE HP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORA OBANNON (OWNER OPERATOR)
(480) 890-5720
Entity
Organization
Contact information
Practice address
1616 E MAIN ST, 208 E, MESA, AZ 85203-9071
(480) 890-5720
Mailing address
1616 E MAIN ST, 208 E, MESA, AZ 85203-9071
(480) 890-5720
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
24
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
927585
AHCCCS ID NUMBER
AZ
Enumeration date
06/20/2007
Last updated
08/22/2020
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