Provider Demographics
NPI:1720414170
Name:HOLLOWAY HOME CARE SERVICE
Entity Type:Organization
Organization Name:HOLLOWAY HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-274-9095
Mailing Address - Street 1:1508 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-9614
Mailing Address - Country:US
Mailing Address - Phone:769-274-9095
Mailing Address - Fax:601-625-8401
Practice Address - Street 1:1508 PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-9614
Practice Address - Country:US
Practice Address - Phone:769-274-9095
Practice Address - Fax:601-625-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA012487251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health