Provider Demographics
NPI:1124596390
Name:OLIVE BRANCH AUTISM SERVICES
Entity type:Organization
Organization Name:OLIVE BRANCH AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVES
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:916-794-2326
Mailing Address - Street 1:5750 SUNRISE BLVD STE 210B
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7639
Mailing Address - Country:US
Mailing Address - Phone:916-794-2326
Mailing Address - Fax:916-626-4682
Practice Address - Street 1:5750 SUNRISE BLVD STE 210B
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7639
Practice Address - Country:US
Practice Address - Phone:916-794-2326
Practice Address - Fax:916-626-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty