Provider Demographics
NPI:1881172120
Name:HOLYOAK BROS
Entity type:Organization
Organization Name:HOLYOAK BROS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-838-5422
Mailing Address - Street 1:1455 E GUADALUPE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3951
Mailing Address - Country:US
Mailing Address - Phone:480-838-5422
Mailing Address - Fax:480-838-3794
Practice Address - Street 1:1455 E GUADALUPE RD STE 2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3951
Practice Address - Country:US
Practice Address - Phone:480-838-5422
Practice Address - Fax:480-838-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental