Healthcare Provider Details

I. General information

NPI: 1184842544
Provider Name (Legal Business Name): HOLLY HILL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 DABNEY DR
HENDERSON NC
27536-3946
US

IV. Provider business mailing address

3019 FALSTAFF RD
RALEIGH NC
27610-1812
US

V. Phone/Fax

Practice location:
  • Phone: 252-431-0072
  • Fax: 252-431-0490
Mailing address:
  • Phone: 919-250-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number4481
License Number StateNC

VIII. Authorized Official

Name: MR. TOM RYBA
Title or Position: CHIEF EXCECUTIVE OFFICER
Credential:
Phone: 919-250-7186