Provider Demographics
NPI:1467621573
Name:D. HOLMES RESIDENTIAL CARE, INC.
Entity Type:Organization
Organization Name:D. HOLMES RESIDENTIAL CARE, INC.
Other - Org Name:HOLMES COUNSELING AND THERAPUTIC NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-695-6684
Mailing Address - Street 1:4763 PURITAN CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-8341
Mailing Address - Country:US
Mailing Address - Phone:813-695-6684
Mailing Address - Fax:813-232-6195
Practice Address - Street 1:4763 PURITAN CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-8341
Practice Address - Country:US
Practice Address - Phone:813-695-6684
Practice Address - Fax:813-232-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10103310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL238031OtherGROUP NUMBER AMERICGROUP