| Optimal Health & Balance Llc | |
|
6925 184th Ave Bristol WI 53104-9747 | |
| (262) 358-2954 | |
| Not Available |
| Full Name | Optimal Health & Balance Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6925 184th Ave, Bristol, Wisconsin |
| Authorized Official Name and Position | Imelda N Forsberg (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 2623582954 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Health & Balance Llc 6925 184th Avenue Bristol WI 53104-9747 Ph: (262) 358-2954 | Optimal Health & Balance Llc 6925 184th Ave Bristol WI 53104-9747 Ph: (262) 358-2954 |
| NPI Number | 1255072708 |
|---|---|
| Provider Enumeration Date | 04/06/2022 |
| Last Update Date | 04/06/2022 |
| Certification Date | 04/06/2022 |
| Medicare PECOS PAC ID | 6507232212 |
|---|---|
| Medicare Enrollment ID | O20221021000114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255072708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Imelda N Forsberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306027891 PECOS PAC ID: 8426132994 Enrollment ID: I20120809000834 |
Heal From Within Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6401 205th Ave, Bristol, WI 53104 Phone: 847-774-2264 |