Healthcare Provider Details

I. General information

NPI: 1679253850
Provider Name (Legal Business Name): HOLLYHOMECARELLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 ROUTE 38 STE 200
MOUNT LAUREL NJ
08054-9765
US

IV. Provider business mailing address

3221 ROUTE STE 200
MOUNT LAUREL PA
08054
US

V. Phone/Fax

Practice location:
  • Phone: 800-698-5038
  • Fax:
Mailing address:
  • Phone: 180-698-5038
  • 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 Number
License Number State

VIII. Authorized Official

Name: SHARI NICOLE CROOM
Title or Position: OWNER
Credential:
Phone: 215-221-2597