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NPI Code Detail

MEDICARE: OLIVE BRANCH RESIDENTIAL, LLC

MEDICARE: OLIVE BRANCH RESIDENTIAL, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1225127426
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLIVE BRANCH RESIDENTIAL, LLC
Provider Business Mailing Address
First Line : 9684 GOODMAN RD
Second Line :
City : OLIVE BRANCH
State : MS
Zip : 38654-1726
Country : US
Telephone Number : 662-895-7609
Fax Number : 662-895-3501
Provider Business Practice Location Address
First Line : 9684 GOODMAN RD
Second Line :
City : OLIVE BRANCH
State : MS
Zip : 38654-1726
Country : US
Telephone Number : 662-895-7609
Fax Number : 662-895-3501
Authorized Official
Title or Position : MANAGER
Name : KYLE TIMOTHY SCHADE
Credential :
Telephone Number : 573-471-1113
Provider Enumeration Date : 10/12/2006
Last Update Date : 03/10/2026

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Directions to “OLIVE BRANCH RESIDENTIAL, LLC ” Practice Location

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