Healthcare Provider Details

I. General information

NPI: 1841723905
Provider Name (Legal Business Name): HOLLY HILL NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 1ST AVE
SULPHUR LA
70663-3424
US

IV. Provider business mailing address

921 1ST AVENUE
SULPHUR LA
70663
US

V. Phone/Fax

Practice location:
  • Phone: 337-527-6385
  • Fax:
Mailing address:
  • Phone: 337-527-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN SCHLAMP
Title or Position: MD
Credential:
Phone: 337-527-6385