Healthcare Provider Details

I. General information

NPI: 1396963286
Provider Name (Legal Business Name): OLANIYAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CARN ST
WALTERBORO SC
29488-3923
US

IV. Provider business mailing address

112 CARN ST
WALTERBORO SC
29488-3923
US

V. Phone/Fax

Practice location:
  • Phone: 843-549-5207
  • Fax: 843-549-5207
Mailing address:
  • Phone: 843-549-5207
  • Fax: 843-549-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. RADICLANI CLYTUS
Title or Position: OWNER
Credential:
Phone: 843-542-9290