Provider Demographics
NPI:1124873567
Name:FORT MYERS OSL OPERATING LLC
Entity type:Organization
Organization Name:FORT MYERS OSL OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-562-9287
Mailing Address - Street 1:12811 KENWOOD LN STE 218
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5645
Mailing Address - Country:US
Mailing Address - Phone:239-292-1513
Mailing Address - Fax:
Practice Address - Street 1:14521 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-2829
Practice Address - Country:US
Practice Address - Phone:239-481-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121903700Medicaid