Organization
OLIVE GROVE LLC
Active
Other names
Olive Grove Residential Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROYCE LONG (CORPORATE OFFICER/PRESIDENT)
(714) 981-9081
Entity
Organization
Contact information
Practice address
9446 BACK BAY CIR, LAS VEGAS, NV 89123-5947
(702) 413-6947
(702) 359-1983
Mailing address
723 E KIRKWALL RD, GLENDORA, CA 91740-5715
(714) 981-9081
(702) 359-1983
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
76654GC-1
NV
Other
Enumeration date
03/12/2014
Last updated
03/12/2014
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