1164722211 NPI number — HOLIDAY QUALITY CARE SERVICES INC.

Table of content: (NPI 1164722211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164722211 NPI number — HOLIDAY QUALITY CARE SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLIDAY QUALITY CARE SERVICES 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:
JUDY HOLIDAY
Provider Other Organization Name Type Code:
4
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:
1164722211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17270 89TH PL N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOXAHATCHEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33470-1744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-784-7414
Provider Business Mailing Address Fax Number:
561-791-3211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17270 89TH PL N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOXAHATCHEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33470-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-784-7414
Provider Business Practice Location Address Fax Number:
561-791-3211
Provider Enumeration Date:
10/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HOLIDAY
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
C.EO./WAIVER SUPPORT COORDINATOR
Authorized Official Telephone Number:
561-784-7414

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  676963296 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 751580496 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 751580498 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 676963268 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 751580468 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 676963296 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 676963298 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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