Healthcare Provider Details

I. General information

NPI: 1639098247
Provider Name (Legal Business Name): OLIVE TREE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HIGHLAND AVE
ABINGTON PA
19001-3703
US

IV. Provider business mailing address

1111 HIGHLAND AVE
ABINGTON PA
19001-3703
US

V. Phone/Fax

Practice location:
  • Phone: 347-898-1413
  • Fax: 215-886-2123
Mailing address:
  • Phone: 347-989-1413
  • Fax: 215-886-2123

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: DR. ADIGUN OLATUBOSUN ITABIYI
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 347-898-1413