Provider Demographics
NPI:1528857612
Name:OLI AND FLO LLC
Entity type:Organization
Organization Name:OLI AND FLO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMNISTARTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:SSENKUBUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-310-6648
Mailing Address - Street 1:7711 S 68TH DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2751
Mailing Address - Country:US
Mailing Address - Phone:818-310-6648
Mailing Address - Fax:
Practice Address - Street 1:5127 W MALDONADO RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6918
Practice Address - Country:US
Practice Address - Phone:818-310-6648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility