Provider Demographics
NPI:1407158173
Name:HOLLA AT A DOC PROGRAM CORP
Entity Type:Organization
Organization Name:HOLLA AT A DOC PROGRAM CORP
Other - Org Name:HOLLA AT A DOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-955-3815
Mailing Address - Street 1:9030 SABLE TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-2589
Mailing Address - Country:US
Mailing Address - Phone:832-955-3815
Mailing Address - Fax:682-651-0699
Practice Address - Street 1:9030 SABLE TERRACE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-2589
Practice Address - Country:US
Practice Address - Phone:832-955-3815
Practice Address - Fax:682-651-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health