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General NPI Number Information
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NPI Number | 1679382394
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Entity Type | Organization
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Legal Business Name | OLIVE TREE HOME CARE LLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 4301 WATERFORD GLEN DR
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City | MANSFIELD
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State | TX
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Zip | 76063-9104
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Country | US
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Telephone | 469-694-8001
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Fax | 469-613-4007
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Provider Business Mailing Address
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Address Line | 4301 WATERFORD GLEN DR
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City | MANSFIELD
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State | TX
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Zip | 76063-9104
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Country | US
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Telephone | 469-694-8001
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Fax | 469-613-4007
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Authorized Official
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Title or Position | CONSULTANT
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Name | ELLEN CLINTON
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Credential |
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Telephone | 817-903-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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