Olive Grove LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

76654GC-1 Issued in NV

Legal business name

OLIVE GROVE LLC

Doing business as

Olive Grove Residential Care

Practice address

9446 Back Bay Cir
Las Vegas, NV 89123-5947

Phone

(702) 413-6947

Fax

(702) 359-1983

NPI assigned

Mar 12, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Royce Long

Title

Corporate Officer/President

Phone

(714) 981-9081

Specialties & licenses 1

Addresses

Other names 1

• Olive Grove Residential Care Doing business as

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394582400000",
    "number": "1699191775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 E KIRKWALL RD",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917405715",
            "telephone_number": "714-981-9081",
            "fax_number": "702-359-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9446 BACK BAY CIR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891235947",
            "telephone_number": "702-413-6947",
            "fax_number": "702-359-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE GROVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-12",
        "last_updated": "2014-03-12",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "ROYCE",
        "authorized_official_title_or_position": "CORPORATE OFFICER/PRESIDENT",
        "authorized_official_telephone_number": "714-981-9081",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NV",
            "license": "76654GC-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olive Grove Residential Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Adult Care Home Facility in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.