Healthcare Provider Details

I. General information

NPI: 1164753190
Provider Name (Legal Business Name): HOLCOMB ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 PENNSYLVANIA AVE
SEAFORD DE
19973-3817
US

IV. Provider business mailing address

467 CREAMERY WAY
EXTON PA
19341-2508
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-7900
  • Fax: 302-629-7954
Mailing address:
  • Phone: 610-363-2148
  • Fax: 610-363-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA JACKSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 610-363-1488