=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891953725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLIVE GLEN FOUNDATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2008
-----------------------------------------------------
Last Update Date | 05/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3025 BECERRA WY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-486-1161
-----------------------------------------------------
Fax | 916-484-7010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3025 BECERRA WY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-486-1161
-----------------------------------------------------
Fax | 916-484-7010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CHRISTIAN SCIENCE NURSI
-----------------------------------------------------
Name | MARGARET ANN LAWRENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-486-4382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282J00000X
-----------------------------------------------------
Taxonomy Name | Religious Nonmedical Health Care Institution
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------