Healthcare Provider Details

I. General information

NPI: 1063324119
Provider Name (Legal Business Name): OLIVE BRANCH BEHAVIORAL HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 CAROLINE AVE
TOLEDO OH
43612-1923
US

IV. Provider business mailing address

4123 CAROLINE AVE
TOLEDO OH
43612-1923
US

V. Phone/Fax

Practice location:
  • Phone: 419-376-3021
  • Fax:
Mailing address:
  • Phone: 419-376-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFRED DARNELL GARDNER II
Title or Position: CEO/CFO
Credential:
Phone: 419-376-3021