MEDICARE: OLIVE BRANCH HOME CARE SERVICES

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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770226516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE BRANCH HOME CARE SERVICES

Provider Business Mailing Address
First Line	:	552 MEMORIAL DRIVE EXT STE 200
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-1135
Country	:	US
Telephone Number	:	843-713-1104
Fax Number	:

Provider Business Practice Location Address
First Line	:	552 MEMORIAL DRIVE EXT STE 200
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-1135
Country	:	US
Telephone Number	:	843-713-1104
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTIE COHENS
Credential	:
Telephone Number	:	864-551-5428

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	04/19/2022

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