Provider Demographics
NPI:1346347739
Name:HOLLADAY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:HOLLADAY HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-2111
Mailing Address - Street 1:410 HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1603
Mailing Address - Country:US
Mailing Address - Phone:336-760-3444
Mailing Address - Fax:336-760-2769
Practice Address - Street 1:410 HARVEY ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1603
Practice Address - Country:US
Practice Address - Phone:336-760-3444
Practice Address - Fax:336-760-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00093332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0346130Medicaid
NC0346130Medicaid