Organization Active NPI

Optimal Home Care LLC

  • In Home Supportive Care Agency
  • Winston Salem, NC
National Provider Identifier
1063019180
Registry record updated Mar 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
OPTIMAL HOME CARE LLC
Practice address
105 Fair Oaks LN
Winston Salem, NC 27127-3173
Phone
(336) 727-3345
Fax
(336) 727-3345
NPI assigned
Oct 1, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tahesia McKnight
Title
Director
Phone
(336) 727-3345

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
In Home Supportive Care Agency 253Z00000X Primary
Respite Care 385H00000X

Addresses

Primary practice location

105 Fair Oaks LN
Winston Salem, NC 27127-3173

Mailing address

105 Fair Oaks LN
Winston Salem, NC 27127-3173
Phone (336) 727-3345

Other identifiers 1

IdentifierTypeStateIssuer
1063019180MedicaidNC

National Provider Directory

National Provider Directory

Locations

105 Fair Oaks Ln
Winston Salem, NC 27127
Phone (336) 727-3345

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616716800000",
    "number": "1063019180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 FAIR OAKS LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271273173",
            "telephone_number": "336-727-3345",
            "fax_number": "336-652-3155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 FAIR OAKS LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271273173",
            "telephone_number": "336-727-3345",
            "fax_number": "336-727-3345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-01",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A",
        "authorized_official_last_name": "MCKNIGHT",
        "authorized_official_first_name": "TAHESIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-727-3345"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063019180",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.