Provider Demographics
NPI:1285524991
Name:OPTIMAL WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:OPTIMAL WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INTISAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-412-3318
Mailing Address - Street 1:4640 SLATER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4044
Mailing Address - Country:US
Mailing Address - Phone:612-946-2224
Mailing Address - Fax:612-288-1805
Practice Address - Street 1:4640 SLATER RD STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4044
Practice Address - Country:US
Practice Address - Phone:612-946-2224
Practice Address - Fax:612-288-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)