October Ventures LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

HCO 13919 Issued in VA

Legal business name

OCTOBER VENTURES LLC

Doing business as

OptimumCare Home Care Servces

Practice address

3683 Fettler Park Dr
Dumfries, VA 22025-2049

Phone

(703) 490-8003

Fax

(703) 995-4585

NPI assigned

Jan 22, 2013

Last updated

Jun 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anim Addo Sampong

Title

Owner

Phone

(703) 490-8003

Specialties & licenses 1

Addresses

Other names 1

• OptimumCare Home Care Servces Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336487537. Details of each certification follow.

• CCN 497812 Home health agency · Active · Details

Home health agency certification: CCN 497812

Legal name

OCTOBER VENTURES LLC

Doing business as

OPTIMUMCARE HOME CARE SERVICES

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 3, 2024

Last certification

Apr 19, 2024

Organization structure

LLCProprietary

Enrollment address

3683 Fettler Park Dr
Dumfries, VA 22025-2049

Listed as

Optimumcare Home Care ServicesCCN 497812 · All quality measures

Ownership

-

Certified

May 3, 2024

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1336487537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3683 FETTLER PARK DR",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220252049",
            "telephone_number": "703-490-8003",
            "fax_number": "703-995-4585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3683 FETTLER PARK DR",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220252049",
            "telephone_number": "703-490-8003",
            "fax_number": "703-995-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTOBER VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-22",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "SAMPONG",
        "authorized_official_first_name": "ANIM",
        "authorized_official_middle_name": "ADDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-490-8003"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "VA",
            "license": "HCO 13919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OptimumCare Home Care Servces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in Dumfries, VA
• Providers in Dumfries, VA by specialty
• Home Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.