Healthcare Provider Details

I. General information

NPI: 1477824548
Provider Name (Legal Business Name): HOLLOWAYS HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2012
Last Update Date: 01/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 METHVEN LN
RENO TX
75462-7222
US

IV. Provider business mailing address

190 METHVEN LN
RENO TX
75462-7222
US

V. Phone/Fax

Practice location:
  • Phone: 903-739-2712
  • 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 StateTX

VIII. Authorized Official

Name: MR. KENNETH MACK HOLLOWAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-272-5375