Provider Demographics
NPI:1043456601
Name:HOLLYCARE
Entity Type:Organization
Organization Name:HOLLYCARE
Other - Org Name:HOLLYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:NWIGWE
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:713-436-1088
Mailing Address - Street 1:11403 EASTON SPRINGS DR
Mailing Address - Street 2:11403 EASTON SPRING DR
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2519
Mailing Address - Country:US
Mailing Address - Phone:713-436-1088
Mailing Address - Fax:
Practice Address - Street 1:11403 EASTON SPRINGS DR
Practice Address - Street 2:ADALEXIS2000@YAHOO.COM
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2519
Practice Address - Country:US
Practice Address - Phone:713-436-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities