Provider Demographics
NPI:1043780943
Name:HOLLOMAN CARE CDS LLC
Entity Type:Organization
Organization Name:HOLLOMAN CARE CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-413-6393
Mailing Address - Street 1:3440 W DIVISION ST STE I
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-1187
Mailing Address - Country:US
Mailing Address - Phone:417-413-6303
Mailing Address - Fax:
Practice Address - Street 1:3440 W DIVISION ST STE I
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-1187
Practice Address - Country:US
Practice Address - Phone:417-413-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health