Provider Demographics
NPI:1730781758
Name:OLIVIAS FRIENDS CARE MANAGEMENT AGENCY LLC
Entity type:Organization
Organization Name:OLIVIAS FRIENDS CARE MANAGEMENT AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:585-333-0299
Mailing Address - Street 1:333 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1254
Mailing Address - Country:US
Mailing Address - Phone:585-333-0299
Mailing Address - Fax:
Practice Address - Street 1:333 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1254
Practice Address - Country:US
Practice Address - Phone:585-333-0299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management