Provider Demographics
NPI:1427352293
Name:OLSL NEW YORK OPERATING COMPANY LLC
Entity type:Organization
Organization Name:OLSL NEW YORK OPERATING COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-7608
Mailing Address - Street 1:12 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4048
Mailing Address - Country:US
Mailing Address - Phone:516-933-0002
Mailing Address - Fax:
Practice Address - Street 1:12 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4048
Practice Address - Country:US
Practice Address - Phone:516-933-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLSL NEW YORK OPERATING COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility