Provider Demographics
NPI:1215407994
Name:PRIVATE HEALTHCARE FACILITIES
Entity Type:Organization
Organization Name:PRIVATE HEALTHCARE FACILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-996-2340
Mailing Address - Street 1:902 KITTY HAWK RD # 170487
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3825
Mailing Address - Country:US
Mailing Address - Phone:866-996-2340
Mailing Address - Fax:
Practice Address - Street 1:1171 MARKET ST STE 112
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6502
Practice Address - Country:US
Practice Address - Phone:866-996-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIVATE HEALTHCARE FACILITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-26
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes282N00000XHospitalsGeneral Acute Care Hospital