Provider Demographics
NPI:1356689426
Name:HOLE IN ONE, INC.
Entity Type:Organization
Organization Name:HOLE IN ONE, INC.
Other - Org Name:ONE ON ONE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTYE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-288-1300
Mailing Address - Street 1:300 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8903
Mailing Address - Country:US
Mailing Address - Phone:540-288-1300
Mailing Address - Fax:540-657-0723
Practice Address - Street 1:300 GARRISONVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8903
Practice Address - Country:US
Practice Address - Phone:540-288-1300
Practice Address - Fax:540-657-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-12801251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101695770Medicaid
VA0101696075Medicaid
VA0151433635Medicaid