Provider Demographics
NPI:1073840575
Name:HOLLY'S HOMES, L.L.C.
Entity Type:Organization
Organization Name:HOLLY'S HOMES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:256-483-1543
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-0044
Mailing Address - Country:US
Mailing Address - Phone:256-486-1330
Mailing Address - Fax:256-894-5628
Practice Address - Street 1:1956 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-4325
Practice Address - Country:US
Practice Address - Phone:256-894-5628
Practice Address - Fax:256-894-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health