Provider Demographics
NPI:1174757710
Name:OLIVE HOME CARE SERVICES INC
Entity type:Organization
Organization Name:OLIVE HOME CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GANIYU
Authorized Official - Middle Name:O
Authorized Official - Last Name:KASUMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-997-8949
Mailing Address - Street 1:808 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-7192
Mailing Address - Country:US
Mailing Address - Phone:770-997-8949
Mailing Address - Fax:770-997-8909
Practice Address - Street 1:808 COMMERCE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-7192
Practice Address - Country:US
Practice Address - Phone:770-997-8949
Practice Address - Fax:770-997-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031R0047251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health