Provider Demographics
NPI:1124292313
Name:OLIVE BRANCH CARE SERVICES, INC.
Entity type:Organization
Organization Name:OLIVE BRANCH CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:HAERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-357-3795
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92609-0939
Mailing Address - Country:US
Mailing Address - Phone:949-357-3795
Mailing Address - Fax:949-916-9971
Practice Address - Street 1:27716 TORIJA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-1412
Practice Address - Country:US
Practice Address - Phone:949-357-3795
Practice Address - Fax:949-916-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility