1841989126 NPI number — OPTIMAL QUALITY HEALTH SOLUTIONS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841989126 NPI number — OPTIMAL QUALITY HEALTH SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMAL QUALITY HEALTH SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841989126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 WHEATON PL APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-3322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-447-6084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4210 LEEDS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-447-6084
Provider Business Practice Location Address Fax Number:
443-315-5609
Provider Enumeration Date:
05/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
COUTHER
Authorized Official First Name:
TANEA
Authorized Official Middle Name:
MARLENE
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
443-447-0684

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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