Provider Demographics
NPI:1679253850
Name:HOLLYHOMECARELLC
Entity Type:Organization
Organization Name:HOLLYHOMECARELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BOOKER HOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-221-2597
Mailing Address - Street 1:118 MERIDIAN LN
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3848
Mailing Address - Country:US
Mailing Address - Phone:215-221-2597
Mailing Address - Fax:
Practice Address - Street 1:118 MERIDIAN LN
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3848
Practice Address - Country:US
Practice Address - Phone:215-221-2597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities