Healthcare Provider Details

I. General information

NPI: 1518037233
Provider Name (Legal Business Name): HOLLY HILL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 FALSTAFF RD
RALEIGH NC
27610
US

IV. Provider business mailing address

3019 FALSTAFF RD
RALEIGH NC
27610-1812
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-7000
  • Fax:
Mailing address:
  • Phone: 919-250-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number60034722
License Number StateNC

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3482