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General NPI Number Information
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NPI Number | 1730961335
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH HOME HEALTH CARE INC.
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 2424 E YORK ST STE 100-K
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3026
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Country | US
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Telephone | 267-342-5644
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 E YORK ST STE 100-K
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3026
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Country | US
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Telephone | 267-342-5644
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Fax |
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Authorized Official
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Title or Position | SHAWN WISE
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Name | SHAWN WISE
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Credential |
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Telephone | 267-784-7317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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