MEDICARE: OLIVE BRANCH HOME HEALTH CARE

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	253Z00000X	In Home Supportive Care Agency		MO
2	251E00000X	Home Health Agency		MO

General Provider Information

NPI Number	:	1861908048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE BRANCH HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	1720 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1721
Country	:	US
Telephone Number	:	314-472-3224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1721
Country	:	US
Telephone Number	:	314-472-3224
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOHN ROBINSON
Credential	:
Telephone Number	:	314-472-3224

Provider Enumeration Date	:	12/24/2017
Last Update Date	:	12/24/2017

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