Provider Demographics
NPI:1972647121
Name:OLSL MERRIMACK
Entity Type:Organization
Organization Name:OLSL MERRIMACK
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:502-779-7512
Mailing Address - Fax:502-779-4747
Practice Address - Street 1:85 STOREY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3571
Practice Address - Country:US
Practice Address - Phone:978-462-7324
Practice Address - Fax:978-462-7325
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
MA1905805OtherPROVIDER NUMBER