Healthcare Provider Details

I. General information

NPI: 1205760980
Provider Name (Legal Business Name): HOLLYS ANGELS AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 11TH ST
CAMPBELL OH
44405-1708
US

IV. Provider business mailing address

34 11TH ST
CAMPBELL OH
44405-1708
US

V. Phone/Fax

Practice location:
  • Phone: 330-360-6137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLY ANN PHILLIPS
Title or Position: OWNER
Credential: STNA
Phone: 330-360-6137