Provider Demographics
NPI:1760109391
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:OWNER AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUINDRA
Authorized Official - Middle Name:
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 SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4405
Mailing Address - Country:US
Mailing Address - Phone:915-240-5618
Mailing Address - Fax:
Practice Address - Street 1:5245 CENTENNIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4405
Practice Address - Country:US
Practice Address - Phone:915-240-5618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLIVEBRANCH UNITY HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child