Provider Demographics
NPI:1184842544
Name:HOLLY HILL HOSPITAL
Entity Type:Organization
Organization Name:HOLLY HILL HOSPITAL
Other - Org Name:PSI INC OF NC DBA HOLLY HILL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXCECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-250-7186
Mailing Address - Street 1:3019 FALSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1812
Mailing Address - Country:US
Mailing Address - Phone:919-250-7000
Mailing Address - Fax:
Practice Address - Street 1:510 DABNEY DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3946
Practice Address - Country:US
Practice Address - Phone:252-431-0072
Practice Address - Fax:252-431-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4481283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102736Medicaid