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General NPI Number Information
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NPI Number | 1689957912
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Entity Type | Organization
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Legal Business Name | OLIVE TREE, LLC
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 2028 LIBERTY RD
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City | ELDERSBURG
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State | MD
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Zip | 21784-6677
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Country | US
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Telephone | 410-795-4686
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Fax | 410-795-9582
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Provider Business Mailing Address
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Address Line | 11301 BISHOPS GATE LN
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City | LAUREL
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State | MD
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Zip | 20723-2052
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Country | US
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Telephone | 646-670-8718
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. GRACE LEE
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Credential |
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Telephone | 646-670-8718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | MD
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