Healthcare Provider Details

I. General information

NPI: 1942118443
Provider Name (Legal Business Name): OLIVE BRANCH RANCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 GRACE CT
LEMOORE CA
93245-2881
US

IV. Provider business mailing address

164 GRACE CT
LEMOORE CA
93245-2881
US

V. Phone/Fax

Practice location:
  • Phone: 559-633-6039
  • Fax: 559-633-6039
Mailing address:
  • Phone: 559-633-6039
  • Fax: 559-633-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER M MALLARD
Title or Position: PRESIDENT & CO-FOUNDER
Credential: MALLARD
Phone: 559-633-6039