Organization
OLSL MARINA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY LANHAM (CHIEF ACCOUNTING OFFICER)
(502) 779-7512
Entity
Organization
Contact information
Practice address
4 SEAPORT DR, NORTH QUINCY, MA 02171-1591
(617) 770-3264
(617) 770-3682
Mailing address
401 S 4TH ST, SUITE 1900, LOUISVILLE, KY 40202-3426
(617) 770-3264
(617) 770-3682
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1905813
PROVIDER NUMBER
MA
Enumeration date
02/19/2007
Last updated
08/22/2020
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