Healthcare Provider Details

I. General information

NPI: 1336628585
Provider Name (Legal Business Name): HOLLIDAY HORIZONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 425
PHOENIX AZ
85016-4881
US

IV. Provider business mailing address

2801 CENTERVILLE ROAD, PMB 698
WILMINGTON DE
19808
US

V. Phone/Fax

Practice location:
  • Phone: 602-952-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM HOLLIDAY
Title or Position: MANAGER
Credential:
Phone: 602-952-8111