1457570673 NPI number — HOLLY HEALTH CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457570673 NPI number — HOLLY HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLLY HEALTH CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457570673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 805
Provider Second Line Business Mailing Address:
516 MAIN ST
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39350-0805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-416-1664
Provider Business Mailing Address Fax Number:
601-656-8510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39350-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-416-1664
Provider Business Practice Location Address Fax Number:
601-650-8510
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SORIANO
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
HELTON
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
601-416-1664

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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