Provider Demographics
NPI:1518146620
Name:OLIVE HOLDINGS, LLC
Entity Type:Organization
Organization Name:OLIVE HOLDINGS, LLC
Other - Org Name:AVIARA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:262 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2975
Mailing Address - Country:US
Mailing Address - Phone:801-447-9823
Mailing Address - Fax:
Practice Address - Street 1:944 REGAL RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4634
Practice Address - Country:US
Practice Address - Phone:760-944-0331
Practice Address - Fax:760-634-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518146620Medicaid
CALTC55323HMedicaid
CA555323Medicare Oscar/Certification