# OLIVE BRANCH ASSISTED LIVING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245963610
- **Authorized official:** RUSSELL APPLETON (MANAGER)
- **Authorized official phone:** (602) 618-3756

## Contact information

- **Practice address:** 1121 N OLIVE AVE, CASA GRANDE, AZ 85122-3418
- **Practice address phone:** (602) 618-3756
- **Mailing address:** 4726 E WHITE ASTER ST, PHOENIX, AZ 85044-4908
- **Mailing address phone:** (602) 618-3756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | — |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 07/05/2022
- **Last updated:** 07/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | BH7438 | — | AZ |