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General NPI Number Information
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NPI Number | 1649557604
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Entity Type | Organization
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Legal Business Name | OLMM PROPERTIES, LLC.
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 4205 RICHMOND MDWS
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City | TEXARKANA
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State | TX
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Zip | 75503-0103
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Country | US
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Telephone | 903-838-7319
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Fax | 903-838-0494
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Provider Business Mailing Address
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Address Line | 4205 RICHMOND MDWS
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City | TEXARKANA
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State | TX
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Zip | 75503-0103
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Country | US
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Telephone | 903-838-7319
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Fax | 903-838-0494
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ANTONIO OTERO
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Credential |
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Telephone | 903-838-7319
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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 | 104639
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License Number State | TX
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