Provider Demographics
NPI:1669516811
Name:OLSL MARINA
Entity type:Organization
Organization Name:OLSL MARINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-7512
Mailing Address - Street 1:401 S 4TH ST
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3426
Mailing Address - Country:US
Mailing Address - Phone:617-770-3264
Mailing Address - Fax:617-770-3682
Practice Address - Street 1:4 SEAPORT DR
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1591
Practice Address - Country:US
Practice Address - Phone:617-770-3264
Practice Address - Fax:617-770-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1905813OtherPROVIDER NUMBER