Provider Demographics
NPI:1669796777
Name:OGLETHORPE OF LONGVIEW LLC
Entity type:Organization
Organization Name:OGLETHORPE OF LONGVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-978-1933
Mailing Address - Street 1:13406 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6822
Mailing Address - Country:US
Mailing Address - Phone:352-597-5075
Mailing Address - Fax:352-597-9644
Practice Address - Street 1:22 BERMUDA LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2902
Practice Address - Country:US
Practice Address - Phone:903-291-3456
Practice Address - Fax:903-663-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital