Healthcare Provider Details

I. General information

NPI: 1407150402
Provider Name (Legal Business Name): HOLLY HILL CHILDREN'S HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 BLUEGRASS DR
HIGHLAND HEIGHTS KY
41076-1577
US

IV. Provider business mailing address

9599 SUMMER HILL RD
CALIFORNIA KY
41007-9055
US

V. Phone/Fax

Practice location:
  • Phone: 859-635-0500
  • Fax:
Mailing address:
  • Phone: 859-635-0500
  • Fax: 859-635-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number800168
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number500027
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number800168
License Number StateKY

VIII. Authorized Official

Name: JAMES SHERRY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 859-635-0500