Healthcare Provider Details

I. General information

NPI: 1427444124
Provider Name (Legal Business Name): HOLIDAY ISLAND OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 HILLSIDE DRIVE
HOLIDAY ISLAND AR
72631
US

IV. Provider business mailing address

89 HILLSIDE DRIVE
HOLIDAY ISLAND AR
72631
US

V. Phone/Fax

Practice location:
  • Phone: 479-253-6553
  • Fax: 479-253-5043
Mailing address:
  • Phone: 479-253-6553
  • Fax: 479-253-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number105
License Number StateAR

VIII. Authorized Official

Name: MR. RAYMOND DENNINGTON MOSS
Title or Position: MANAGER
Credential:
Phone: 479-530-3779