Provider Demographics
NPI:1669823274
Name:OLEMC LLC
Entity Type:Organization
Organization Name:OLEMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAGBODUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-230-7628
Mailing Address - Street 1:2075 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3639
Mailing Address - Country:US
Mailing Address - Phone:727-266-4092
Mailing Address - Fax:
Practice Address - Street 1:2075 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3639
Practice Address - Country:US
Practice Address - Phone:727-266-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility