MEDICARE: HOLMES FOSTER HOMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1629441142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLMES FOSTER HOMES LLC

Provider Business Mailing Address
First Line	:	2233 BURBANK RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2143
Country	:	US
Telephone Number	:	330-234-1699
Fax Number	:

Provider Business Practice Location Address
First Line	:	2233 BURBANK RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2143
Country	:	US
Telephone Number	:	330-234-1699
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DIANE HOLMES
Credential	:
Telephone Number	:	330-234-1699

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	11/05/2015

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