# BLACK OLIVE HEALTH CARE CLINIC

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

## Provider details

- **NPI number:** 1316695380
- **Authorized official:** EDEISHA BROOKS FNP-C (APRN)
- **Authorized official phone:** (419) 295-8811

## Contact information

- **Practice address:** 1415 E DUBLIN GRANVILLE RD STE 100C, COLUMBUS, OH 43229-3311
- **Practice address phone:** (614) 943-3776
- **Practice address fax:** (860) 261-0210
- **Mailing address:** 860 OAKLAND PARK AVE, COLUMBUS, OH 43224-3258
- **Mailing address phone:** (419) 295-8811

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/17/2022
- **Last updated:** 03/16/2026