Provider Demographics
NPI:1760603229
Name:HOLLY HALL
Entity Type:Organization
Organization Name:HOLLY HALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERFORMANCE IMPROVEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLAPPENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:713-799-9033
Mailing Address - Street 1:2000 HOLLY HALL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4032
Mailing Address - Country:US
Mailing Address - Phone:713-799-9031
Mailing Address - Fax:713-799-2702
Practice Address - Street 1:2000 HOLLY HALL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4032
Practice Address - Country:US
Practice Address - Phone:713-799-9031
Practice Address - Fax:713-799-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030124310400000X
TX000123313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019739Medicaid
TX001019739Medicaid