Provider Demographics
NPI:1285632372
Name:HOLLY NURSING CARE CENTER, INC.
Entity Type:Organization
Organization Name:HOLLY NURSING CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVONDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CATHCART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-537-6555
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:CO
Mailing Address - Zip Code:81047-0636
Mailing Address - Country:US
Mailing Address - Phone:719-537-6555
Mailing Address - Fax:719-537-6366
Practice Address - Street 1:320 N 8TH ST
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:CO
Practice Address - Zip Code:81047
Practice Address - Country:US
Practice Address - Phone:719-537-6555
Practice Address - Fax:719-537-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0517314000000X
315D00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05655147Medicaid
CO04138426OtherRESPITE MEDICAID
065351Medicare ID - Type Unspecified