Provider Demographics
NPI:1801658695
Name:PRIVATE HEALTHCARE FACILITIES
Entity type:Organization
Organization Name:PRIVATE HEALTHCARE FACILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-996-2340
Mailing Address - Street 1:902 KITTY HAWK RD # 170487
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3825
Mailing Address - Country:US
Mailing Address - Phone:866-996-2340
Mailing Address - Fax:888-329-2091
Practice Address - Street 1:801 BERG BLVD SE
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1453
Practice Address - Country:US
Practice Address - Phone:866-996-2340
Practice Address - Fax:866-996-2340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIVATE HEALTHCARE FACILITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-26
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing