Healthcare Provider Details

I. General information

NPI: 1609635820
Provider Name (Legal Business Name): HOLLY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 VALLEY BLVD STE 340
EL MONTE CA
91731-2509
US

IV. Provider business mailing address

PO BOX 1521
HONOLULU HI
96806-1521
US

V. Phone/Fax

Practice location:
  • Phone: 626-333-6767
  • Fax:
Mailing address:
  • Phone: 626-333-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KAN KOSUGI
Title or Position: CEO
Credential:
Phone: 626-333-6767