Healthcare Provider Details

I. General information

NPI: 1245374586
Provider Name (Legal Business Name): OLSL LONGMEADOW PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 MALL RD
BURLINGTON MA
01803-4568
US

IV. Provider business mailing address

401 S 4TH ST SUITE 1900
LOUISVILLE KY
40202-3426
US

V. Phone/Fax

Practice location:
  • Phone: 781-270-9008
  • Fax: 781-270-9009
Mailing address:
  • Phone: 502-779-7512
  • Fax: 502-779-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KELLY LANHAM
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 502-779-7512