Basic Information
| Provider Information | |||||||||
| NPI: | 1972647121 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OLSL MERRIMACK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S 4TH ST | ||||||||
| Address2: | SUITE 1900 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027797512 | ||||||||
| FaxNumber: | 5027794747 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 STOREY AVE | ||||||||
| Address2: | |||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019503571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784627324 | ||||||||
| FaxNumber: | 9784627325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LANHAM | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ACCOUNTING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5027797512 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 1905805 | 01 | MA | PROVIDER NUMBER | OTHER |