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General NPI Number Information
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NPI Number | 1407612104
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Entity Type | Organization
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Legal Business Name | OSL OPERATING LLC
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 1321 HERBERT ST
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City | PORT ORANGE
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State | FL
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Zip | 32129-4135
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Country | US
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Telephone | 386-310-4995
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Fax |
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Provider Business Mailing Address
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Address Line | 7015 BERACASA WAY STE 202
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City | BOCA RATON
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State | FL
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Zip | 33433-3453
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Country | US
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Telephone | 239-292-1513
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Fax |
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Authorized Official
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Title or Position | COO
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Name | AYLA HARWOOD
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Credential |
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Telephone | 239-292-1513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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