Provider Demographics
NPI:1194372995
Name:OLIVE BRANCH HOSPICE LLC
Entity Type:Organization
Organization Name:OLIVE BRANCH HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-395-1000
Mailing Address - Street 1:6600 SUGARLOAF PKWY STE 400-204
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4344
Mailing Address - Country:US
Mailing Address - Phone:404-314-8345
Mailing Address - Fax:470-385-6805
Practice Address - Street 1:2302 PARKLAKE DR NE STE 143
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2896
Practice Address - Country:US
Practice Address - Phone:470-395-1000
Practice Address - Fax:470-395-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based