Provider Demographics
NPI:1891781498
Name:HOLIDAY HILL, INC.
Entity Type:Organization
Organization Name:HOLIDAY HILL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DERYL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOYT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:325-625-4157
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-0392
Mailing Address - Country:US
Mailing Address - Phone:325-625-4157
Mailing Address - Fax:325-625-2953
Practice Address - Street 1:245 STATE HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-8757
Practice Address - Country:US
Practice Address - Phone:325-625-4157
Practice Address - Fax:325-625-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109598314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1191480001OtherDMERC
TX675687Medicare Oscar/Certification