Provider Demographics
NPI:1043722564
Name:HOLLY'S HEARING AID CENTER
Entity Type:Organization
Organization Name:HOLLY'S HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROLD
Authorized Official - Suffix:
Authorized Official - Credentials:HAS
Authorized Official - Phone:440-992-0101
Mailing Address - Street 1:2845 N RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4134
Mailing Address - Country:US
Mailing Address - Phone:440-992-0101
Mailing Address - Fax:440-992-0096
Practice Address - Street 1:9875 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6748
Practice Address - Country:US
Practice Address - Phone:440-358-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03062332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050404Medicaid