Provider Demographics
NPI:1164189866
Name:MEDISERV
Entity Type:Organization
Organization Name:MEDISERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOLEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-418-9957
Mailing Address - Street 1:3137 PINE ORCHARD LN APT 202
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4263
Mailing Address - Country:US
Mailing Address - Phone:443-418-9957
Mailing Address - Fax:
Practice Address - Street 1:3137 PINE ORCHARD LN APT 202
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4263
Practice Address - Country:US
Practice Address - Phone:443-418-9957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty