Provider Demographics
NPI:1134509573
Name:OLIVE BRANCH SENIOR CENTER
Entity Type:Organization
Organization Name:OLIVE BRANCH SENIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDANCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUVINE-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:601-270-6939
Mailing Address - Street 1:94 WHEELERTOWN SYLVESTER RD
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-5751
Mailing Address - Country:US
Mailing Address - Phone:601-909-5511
Mailing Address - Fax:
Practice Address - Street 1:94 WHEELERTOWN SYLVESTER RD
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-5751
Practice Address - Country:US
Practice Address - Phone:601-909-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care