Provider Demographics
NPI:1326193277
Name:HOLLISTER'S ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:HOLLISTER'S ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-344-2472
Mailing Address - Street 1:1579 LCR 310
Mailing Address - Street 2:
Mailing Address - City:MART
Mailing Address - State:TX
Mailing Address - Zip Code:76664-5206
Mailing Address - Country:US
Mailing Address - Phone:254-344-2472
Mailing Address - Fax:254-344-2472
Practice Address - Street 1:1579 LCR 310
Practice Address - Street 2:
Practice Address - City:MART
Practice Address - State:TX
Practice Address - Zip Code:76664-5206
Practice Address - Country:US
Practice Address - Phone:254-344-2472
Practice Address - Fax:254-344-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000422310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility