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General NPI Number Information
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NPI Number | 1669823274
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Entity Type | Organization
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Legal Business Name | OLEMC LLC
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 2075 RAINBOW DR
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City | CLEARWATER
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State | FL
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Zip | 33765-3639
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Country | US
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Telephone | 727-266-4092
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Fax |
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Provider Business Mailing Address
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Address Line | 2075 RAINBOW DR
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City | CLEARWATER
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State | FL
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Zip | 33765-3639
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Country | US
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Telephone | 727-266-4092
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JAMES A FAGBODUN
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Credential |
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Telephone | 813-230-7628
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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 | FL
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