The Olive Leaf

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

THE OLIVE LEAF

Practice address

19133 Ingomar St
Reseda, CA 91335-1720

Phone

(818) 360-3317

Fax

(818) 357-2437

NPI assigned

Sep 21, 2006

Last updated

Jan 19, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Larry Philip Friedman, M.A.

Title

Administrator

Phone

(818) 231-4283

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316045388. Details of each certification follow.

• CCN 55G505 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G505

Legal name

THE OLIVE LEAF

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Dec 21, 2004

Last certification

Feb 13, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

19133 Ingomar Street
Reseda, CA 91335

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1316045388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19133 INGOMAR ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913351720",
            "telephone_number": "818-360-3317",
            "fax_number": "818-357-2437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19133 INGOMAR ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913351720",
            "telephone_number": "818-360-3317",
            "fax_number": "818-357-2437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OLIVE LEAF",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-231-4283",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "960001402",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual Disabilities Intermediate Care Facility in Reseda, CA
• Providers in Reseda, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.