Healthcare Provider Details

I. General information

NPI: 1609707629
Provider Name (Legal Business Name): BRENDA LEE HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 W SPRING ST
LIMA OH
45805-3249
US

IV. Provider business mailing address

215 N DALE DR
LIMA OH
45805-2251
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-4609
  • Fax:
Mailing address:
  • Phone: 419-604-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: