Provider Demographics
NPI:1487191565
Name:OLIVE BRANCH HOPE CENTER, INC
Entity type:Organization
Organization Name:OLIVE BRANCH HOPE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-508-3514
Mailing Address - Street 1:215 W BANDERA 114 PMB 239
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:210-508-3514
Mailing Address - Fax:210-579-2218
Practice Address - Street 1:215 W BANDERA RD 114 PMB 239
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:210-508-3514
Practice Address - Fax:210-579-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty