Provider Demographics
NPI:1750610572
Name:OLIVET HEALTHCARE, INC
Entity type:Organization
Organization Name:OLIVET HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS
Authorized Official - Phone:630-790-8326
Mailing Address - Street 1:799 ROOSEVELT RD,
Mailing Address - Street 2:BLDG 6, SUITE 316A
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137
Mailing Address - Country:US
Mailing Address - Phone:630-790-8326
Mailing Address - Fax:
Practice Address - Street 1:799 ROOSEVELT RD
Practice Address - Street 2:BLDG 6, SUITE 316A
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5908
Practice Address - Country:US
Practice Address - Phone:630-790-8326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1949873251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health