Organization
OLSL DEDHAM, LLC
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
735 WASHINGTON ST, DEDHAM, MA 02026-4462
(781) 251-9330
(781) 251-9329
Mailing address
401 S 4TH ST, SUITE 1900, LOUISVILLE, KY 40202-3426
(502) 779-7512
(502) 779-4747
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1900820
PROVIDER NUMBER
MA
Enumeration date
02/26/2007
Last updated
08/22/2020
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