Provider Demographics
NPI:1407150402
Name:HOLLY HILL CHILDREN'S HOME, INC.
Entity Type:Organization
Organization Name:HOLLY HILL CHILDREN'S HOME, INC.
Other - Org Name:HOLLY HILL CHILD AND FAMILY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-635-0500
Mailing Address - Street 1:9599 SUMMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:KY
Mailing Address - Zip Code:41007-9055
Mailing Address - Country:US
Mailing Address - Phone:859-635-0500
Mailing Address - Fax:859-635-0504
Practice Address - Street 1:9599 SUMMER HILL RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:KY
Practice Address - Zip Code:41007-9055
Practice Address - Country:US
Practice Address - Phone:859-635-0500
Practice Address - Fax:859-635-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800168251B00000X, 251S00000X
KY500027322D00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100344960Medicaid