Provider Demographics
NPI:1750684742
Name:HOLMES, ANGELA F (OWNER/DIRECTOR)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:F
Last Name:HOLMES
Suffix:
Gender:F
Credentials:OWNER/DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 MARY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7148
Mailing Address - Country:US
Mailing Address - Phone:662-822-2308
Mailing Address - Fax:
Practice Address - Street 1:1421 MARY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7148
Practice Address - Country:US
Practice Address - Phone:662-822-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities