Provider Demographics
NPI:1407612104
Name:OSL OPERATING LLC
Entity Type:Organization
Organization Name:OSL OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-292-1513
Mailing Address - Street 1:7015 BERACASA WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3453
Mailing Address - Country:US
Mailing Address - Phone:239-292-1513
Mailing Address - Fax:
Practice Address - Street 1:1321 HERBERT ST
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4135
Practice Address - Country:US
Practice Address - Phone:386-310-4995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115292000Medicaid