Provider Demographics
NPI:1649942947
Name:HOLLY HOSPICE SERVICES, LLC
Entity type:Organization
Organization Name:HOLLY HOSPICE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:AYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-471-8415
Mailing Address - Street 1:21006 DEVONSHIRE ST, STE 207
Mailing Address - Street 2:21151 SOUTH WESTERN AVENUE STE 284
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311
Mailing Address - Country:US
Mailing Address - Phone:562-471-8415
Mailing Address - Fax:
Practice Address - Street 1:21006 DEVONSHIRE ST, STE 207
Practice Address - Street 2:21006 DEVONSHIRE ST., STE 207
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311
Practice Address - Country:US
Practice Address - Phone:562-471-8415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based