Healthcare Provider Details

I. General information

NPI: 1588799597
Provider Name (Legal Business Name): HOLLY SPRINGS SENIOR CITIZENS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 BIG ISLAND RD
RUTHERFORDTON NC
28139-8779
US

IV. Provider business mailing address

1881 BIG ISLAND RD
RUTHERFORDTON NC
28139-8779
US

V. Phone/Fax

Practice location:
  • Phone: 828-245-7781
  • Fax: 828-247-0107
Mailing address:
  • Phone: 828-245-7781
  • Fax: 828-247-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-081-005
License Number StateNC

VIII. Authorized Official

Name: MR. BRENT W. ALLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 828-245-7781