Healthcare Provider Details

I. General information

NPI: 1871540070
Provider Name (Legal Business Name): HOLLYWELL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 N MAIN ST
RANDOLPH MA
02368-3056
US

IV. Provider business mailing address

975 N MAIN ST
RANDOLPH MA
02368-3056
US

V. Phone/Fax

Practice location:
  • Phone: 781-963-8800
  • Fax: 781-963-8922
Mailing address:
  • Phone: 781-963-8800
  • Fax: 781-963-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0439
License Number StateMA

VIII. Authorized Official

Name: MR. JOSEPH VENO
Title or Position: AUTH. PERSON/ADMINISTRATOR
Credential:
Phone: 781-963-8800