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Organization
OLIVE BRANCH RECOVERY LLC
Active
Organization
OLIVE BRANCH RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILES RAIZADA MD (PROVIDER)
(940) 220-8899
Entity
Organization
Contact information
Practice address
1332 TEASLEY LN STE 180, DENTON, TX 76205-7946
(940) 220-8899
Mailing address
1332 TEASLEY LN STE 180, DENTON, TX 76205-7946
(940) 220-8899
(940) 294-1772
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QE0002X
Emergency Care Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
Other
Enumeration date
06/03/2020
Last updated
08/16/2021
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