Provider Demographics
NPI:1295079523
Name:HOLLY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:HOLLY HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:AMAECHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-796-9536
Mailing Address - Street 1:16418 LANCASTER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5238
Mailing Address - Country:US
Mailing Address - Phone:281-796-9536
Mailing Address - Fax:281-277-0447
Practice Address - Street 1:16418 LANCASTER PLACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5238
Practice Address - Country:US
Practice Address - Phone:281-796-9536
Practice Address - Fax:281-277-0447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLLY HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0138463747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020246Medicaid
TX001020246OtherTPI