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Organization
OLIVE BRANCH ASSISTED LIVING LLC
Active
Organization
OLIVE BRANCH ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL APPLETON (MANAGER)
(602) 618-3756
Entity
Organization
Contact information
Practice address
1121 N OLIVE AVE, CASA GRANDE, AZ 85122-3418
(602) 618-3756
Mailing address
4726 E WHITE ASTER ST, PHOENIX, AZ 85044-4908
(602) 618-3756
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
323P00000X
Psychiatric Residential Treatment Facility
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH7438
—
AZ
Enumeration date
07/05/2022
Last updated
07/05/2022
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