Provider Demographics
NPI:1851182331
Name:OLYMPIC BEHAVIORAL HEALTHCARE LLC
Entity type:Organization
Organization Name:OLYMPIC BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KOULIANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-474-5903
Mailing Address - Street 1:578 EDWARD LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1268
Mailing Address - Country:US
Mailing Address - Phone:716-474-5903
Mailing Address - Fax:
Practice Address - Street 1:578 EDWARD LN
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1268
Practice Address - Country:US
Practice Address - Phone:716-474-5903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care