Provider Demographics
NPI:1265436810
Name:HOLLY HILL MANOR INC.
Entity type:Organization
Organization Name:HOLLY HILL MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MILLARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-823-5310
Mailing Address - Street 1:531 STEVENSON LN
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7607
Mailing Address - Country:US
Mailing Address - Phone:410-823-5310
Mailing Address - Fax:410-583-8148
Practice Address - Street 1:531 STEVENSON LN
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-7607
Practice Address - Country:US
Practice Address - Phone:410-823-5310
Practice Address - Fax:410-583-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03016314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD006204900Medicaid
MD186102600Medicaid
MD215204Medicare ID - Type UnspecifiedMEDICARE #