Provider Demographics
NPI:1841221850
Name:HOLLAND HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:HOLLAND HEALTH SERVICES, INC.
Other - Org Name:HOLLAND RST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-424-7829
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1406
Mailing Address - Country:US
Mailing Address - Phone:360-424-7829
Mailing Address - Fax:360-424-9053
Practice Address - Street 1:1911 E DIVISION ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-6703
Practice Address - Country:US
Practice Address - Phone:360-424-8607
Practice Address - Fax:360-424-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9029927Medicaid
WA9029927Medicaid