MEDICARE: OLIVE GROVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1558233239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE GROVE

Provider Business Mailing Address
First Line	:	14352 PLEASANT ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-5051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14352 PLEASANT ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-5051
Country	:	US
Telephone Number	:	657-377-9298
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JADEN DO
Credential	:
Telephone Number	:	714-757-6077

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “OLIVE GROVE ” Practice Location

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