Provider Demographics
NPI:1407851785
Name:HOLLY HILL RHF HOUSING, INC
Entity Type:Organization
Organization Name:HOLLY HILL RHF HOUSING, INC
Other - Org Name:BISHOP'S GLEN RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-257-5100
Mailing Address - Street 1:900 LPGA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3113
Mailing Address - Country:US
Mailing Address - Phone:386-226-9000
Mailing Address - Fax:386-257-5069
Practice Address - Street 1:900 LPGA BLVD
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3113
Practice Address - Country:US
Practice Address - Phone:386-226-9000
Practice Address - Fax:386-257-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1052096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020951100Medicaid
FLN68OtherBX/BS OF FL
FL020951100Medicaid