Provider Demographics
NPI:1649278508
Name:HOLMES REGIONAL ENTERPRISES, INC.
Entity type:Organization
Organization Name:HOLMES REGIONAL ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:FELKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-434-5687
Mailing Address - Street 1:1131 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4055
Mailing Address - Country:US
Mailing Address - Phone:321-434-3400
Mailing Address - Fax:321-727-1200
Practice Address - Street 1:1131 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4055
Practice Address - Country:US
Practice Address - Phone:321-434-3400
Practice Address - Fax:321-727-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312345332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5177440001Medicare NSC