1265812895 NPI number — OPTIMAL BEGINNINGS, LLC

Table of content: (NPI 1265812895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265812895 NPI number — OPTIMAL BEGINNINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMAL BEGINNINGS, 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:
1265812895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5272 RIVER RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20816-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-718-1716
Provider Business Mailing Address Fax Number:
301-718-1766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5272 RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20816-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-718-1716
Provider Business Practice Location Address Fax Number:
301-718-1766
Provider Enumeration Date:
06/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VISALLI-GOLD
Authorized Official First Name:
DANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
301-718-1716

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11314065 . This is a "BACB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0145840 . This is a "BACB" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 11210359 . This is a "BACB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9641025 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1062969 . This is a "BACB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1063014 . This is a "BACB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1149981 . This is a "BACB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 173745 . This is a "BACB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1107456 . This is a "BACB" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 146026 . This is a "BACB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1096383 . This is a "BACB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1118018 . This is a "BACB" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 745321 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17943 . This is a "DEPARTMENT OF HEALTH AND MENTAL HYGIENE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 980005100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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