Provider Demographics
NPI:1730961335
Name:OLIVE BRANCH HOME HEALTH CARE INC.
Entity type:Organization
Organization Name:OLIVE BRANCH HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAWN WISE
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-784-7317
Mailing Address - Street 1:2424 E YORK ST STE 100-K
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3026
Mailing Address - Country:US
Mailing Address - Phone:267-342-5644
Mailing Address - Fax:
Practice Address - Street 1:2424 E YORK ST STE 100-K
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3026
Practice Address - Country:US
Practice Address - Phone:267-342-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care