Healthcare Provider Details

I. General information

NPI: 1740113281
Provider Name (Legal Business Name): OLIVE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 REDWOOD DR
LEXINGTON KY
40511-1135
US

IV. Provider business mailing address

PO BOX 642
LEXINGTON KY
40588-0642
US

V. Phone/Fax

Practice location:
  • Phone: 859-402-3858
  • Fax:
Mailing address:
  • Phone: 859-536-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTA R HADDAD
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-402-3858