Provider Demographics
NPI:1851945885
Name:OLIVE TREE HOME CARE LLC
Entity Type:Organization
Organization Name:OLIVE TREE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKOONEJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHROKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-497-5878
Mailing Address - Street 1:2606 NW 6TH ST STE 0
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2999
Mailing Address - Country:US
Mailing Address - Phone:352-497-5878
Mailing Address - Fax:
Practice Address - Street 1:2606 NW 6TH ST STE 0
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2999
Practice Address - Country:US
Practice Address - Phone:352-497-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health