1245374586 NPI number — OLSL LONGMEADOW PLACE, 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 1245374586 NPI number — OLSL LONGMEADOW PLACE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLSL LONGMEADOW PLACE, 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:
1245374586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 S 4TH ST
Provider Second Line Business Mailing Address:
SUITE 1900
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-779-7512
Provider Business Mailing Address Fax Number:
502-779-4747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 MALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01803-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-270-9008
Provider Business Practice Location Address Fax Number:
781-270-9009
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LANHAM
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ACCOUNTING OFFICER
Authorized Official Telephone Number:
502-779-7512

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1905821 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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