Provider Demographics
NPI:1134450018
Name:THE OLIVE TREE EXPERIENCE
Entity type:Organization
Organization Name:THE OLIVE TREE EXPERIENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:818-231-4283
Mailing Address - Street 1:7834 VANALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1703
Mailing Address - Country:US
Mailing Address - Phone:818-626-8319
Mailing Address - Fax:818-357-5596
Practice Address - Street 1:7834 VANALDEN AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1703
Practice Address - Country:US
Practice Address - Phone:818-626-8319
Practice Address - Fax:818-357-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-16
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities