Provider Demographics
NPI:1669080644
Name:THE OLIVE FOUNDATION
Entity type:Organization
Organization Name:THE OLIVE FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:OGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-640-0238
Mailing Address - Street 1:6638 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5764
Mailing Address - Country:US
Mailing Address - Phone:202-640-0238
Mailing Address - Fax:602-429-8462
Practice Address - Street 1:6638 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5764
Practice Address - Country:US
Practice Address - Phone:202-640-0238
Practice Address - Fax:602-429-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health