Healthcare Provider Details

I. General information

NPI: 1013359843
Provider Name (Legal Business Name): OLIVE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 COMMERCIAL DR SW
CONYERS GA
30094-5991
US

IV. Provider business mailing address

PO BOX 16404
ATLANTA GA
30321-0404
US

V. Phone/Fax

Practice location:
  • Phone: 770-895-5752
  • Fax:
Mailing address:
  • Phone: 770-895-5752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MAXINE P BURCH
Title or Position: CEO
Credential:
Phone: 770-895-5752