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General NPI Number Information
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NPI Number | 1861908048
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH HOME HEALTH CARE
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Dates
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Enumeration Date | 12/24/2017
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Last Update Date | 12/24/2017
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Provider Practice Location Address
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Address Line | 1720 OLIVE ST
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1721
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Country | US
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Telephone | 314-472-3224
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 OLIVE ST
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1721
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Country | US
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Telephone | 314-472-3224
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN ROBINSON
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Credential |
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Telephone | 314-472-3224
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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 | MO
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Taxonomy #2
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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 | MO
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