Provider Demographics
NPI:1184887374
Name:OPTIMUM CARE CENTER
Entity type:Organization
Organization Name:OPTIMUM CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALVINIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-523-6900
Mailing Address - Street 1:2423 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2001
Mailing Address - Country:US
Mailing Address - Phone:410-523-6900
Mailing Address - Fax:410-523-7109
Practice Address - Street 1:2423 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2001
Practice Address - Country:US
Practice Address - Phone:410-523-6900
Practice Address - Fax:410-523-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy