Provider Demographics
NPI:1093961492
Name:OLIVE TREE ENTERPRISES
Entity Type:Organization
Organization Name:OLIVE TREE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-423-6093
Mailing Address - Street 1:2416 E TYGER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-4953
Mailing Address - Country:US
Mailing Address - Phone:864-423-6093
Mailing Address - Fax:
Practice Address - Street 1:2416 E TYGER BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-4953
Practice Address - Country:US
Practice Address - Phone:864-423-6093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC035175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty