Olive Branch Recovery LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

OLIVE BRANCH RECOVERY LLC

Practice address

1332 Teasley LN Ste 180
Denton, TX 76205-7946

Phone

(940) 220-8899

NPI assigned

Jun 3, 2020

Organization subpart

No

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

Authorized official

Name

Miles Raizada, MDNPI 1548671688

Title

Provider

Phone

(940) 220-8899

Specialties & licenses 7

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miles S Raizada, MD

  • Emergency Medicine Physician
  • Denton, TX
  • NPI 1548671688
  NPD Authorized official
• Jacob P Mumm, M.D.

  • Emergency Medicine Physician
  • Denton, TX
  • NPI 1083024590
  NPD
• Kenneth Alan Dakin, PA-C

  • Physician Assistant
  • Dallas, TX
  • NPI 1740420306
  NPD (past)
• Thomas A White, PA

  • Physician Assistant
  • Richland, WA
  • NPI 1205875564
  NPD (past)

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1508480765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1332 TEASLEY LN STE 180",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762057946",
            "telephone_number": "940-220-8899",
            "fax_number": "940-294-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1332 TEASLEY LN STE 180",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762057946",
            "telephone_number": "940-220-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-03",
        "last_updated": "2021-08-16",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "RAIZADA",
        "authorized_official_first_name": "MILES",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "940-220-8899",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chinyere Emilia Okonkwo
• Ogochukwu Okoye, MD
• Olg Enterprises, LLC
• Sarah Kendra Michelle Olivares, LCDC
• Olive Branch Family Therapy Inc.
• Thomas J Olmsted, DO
• Emily Olson
• Fayokemi Olawale Olusegun
• Job Nyangenya Omanga, LVN
• Mugeer Omar, B.C.,H.I.S.

• Internal Medicine Physician in Denton, TX
• Providers in Denton, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.