Healthcare Provider Details

I. General information

NPI: 1922100312
Provider Name (Legal Business Name): HOLMAN HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 W KARSCH BLVD
FARMINGTON MO
63640-3314
US

IV. Provider business mailing address

669 W KARSCH BLVD
FARMINGTON MO
63640-3314
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-3503
  • Fax:
Mailing address:
  • Phone: 573-756-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number602403909
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number622403905
License Number StateMO

VIII. Authorized Official

Name: DAVID B HOLMAN
Title or Position: PRESIDENT
Credential:
Phone: 573-756-3503