Organization
OLIVE BRANCH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENT P VOLKMER J.D., M.B.A (CHIEF EXECUTIVE OFFICER)
(520) 423-7376
Entity
Organization
Contact information
Practice address
411 W 9TH ST, CASA GRANDE, AZ 85122-3204
(520) 423-7376
Mailing address
411 W 9TH ST, CASA GRANDE, AZ 85122-3204
(520) 423-7376
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH4335
AZ
Other
Enumeration date
12/23/2013
Last updated
12/23/2013
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