=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467396887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLYS NURSING MOBILE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2026
-----------------------------------------------------
Last Update Date | 04/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4430 CRITTENDEN AVE
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46205-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-246-3899
-----------------------------------------------------
Fax | 650-547-5216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4430 CRITTENDEN AVE
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46205-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-246-3899
-----------------------------------------------------
Fax | 650-547-5216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE
-----------------------------------------------------
Name | HOLLY ELAINE OWENS
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 463-246-3899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------