Healthcare Provider Details

I. General information

NPI: 1538194964
Provider Name (Legal Business Name): TIMOTHY LEE HOLMES SR. CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 CENTRAL ROAD APT 102
GLENVIEW IL
60025
US

IV. Provider business mailing address

3519 CENTRAL RD #102
GLENVIEW IL
60025
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-8624
  • Fax:
Mailing address:
  • Phone: 847-729-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberNA348
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: