Provider Demographics
NPI:1184407462
Name:OPTIMAL HOME SERVICE PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:OPTIMAL HOME SERVICE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-399-4028
Mailing Address - Street 1:1048 LINCOLN ST APT 102
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1997
Mailing Address - Country:US
Mailing Address - Phone:651-399-4028
Mailing Address - Fax:
Practice Address - Street 1:1048 LINCOLN ST APT 102
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1997
Practice Address - Country:US
Practice Address - Phone:651-399-4028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty