Provider Demographics
NPI:1730662842
Name:OLIVEBRANCH UNITY HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:OLIVEBRANCH UNITY HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUINDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:915-240-5618
Mailing Address - Street 1:5245 CENTENNIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4405
Mailing Address - Country:US
Mailing Address - Phone:719-354-4733
Mailing Address - Fax:719-374-5534
Practice Address - Street 1:5245 CENTENNIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4405
Practice Address - Country:US
Practice Address - Phone:719-354-4733
Practice Address - Fax:719-374-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health