Provider Demographics
NPI:1467051912
Name:OLIVE BRANCH NUTRITION
Entity Type:Organization
Organization Name:OLIVE BRANCH NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFTHEMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:630-750-0955
Mailing Address - Street 1:9654 KELLEY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-0058
Mailing Address - Country:US
Mailing Address - Phone:630-750-0955
Mailing Address - Fax:
Practice Address - Street 1:9654 KELLEY LN
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-0058
Practice Address - Country:US
Practice Address - Phone:630-750-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-25
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty