Healthcare Provider Details

I. General information

NPI: 1083670590
Provider Name (Legal Business Name): HOLCOMB ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 CREAMERY WAY
EXTON PA
19341-2508
US

IV. Provider business mailing address

467 CREAMERY WAY
EXTON PA
19341-2508
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-1488
  • Fax: 610-363-8273
Mailing address:
  • Phone: 610-363-1488
  • Fax: 610-363-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number157047
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number125990
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number118880
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HELEN KELLY TAYLOR
Title or Position: COMPLIANCE/QA
Credential:
Phone: 610-363-1488