Healthcare Provider Details

I. General information

NPI: 1467396887
Provider Name (Legal Business Name): HOLLYS NURSING MOBILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 CRITTENDEN AVE
INDIANAPOLIS IN
46205-2232
US

IV. Provider business mailing address

4430 CRITTENDEN AVE
INDIANAPOLIS IN
46205-2232
US

V. Phone/Fax

Practice location:
  • Phone: 463-246-3899
  • Fax: 650-547-5216
Mailing address:
  • Phone: 463-246-3899
  • Fax: 650-547-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOLLY ELAINE OWENS
Title or Position: NURSE
Credential: LPN
Phone: 463-246-3899