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General NPI Number Information
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NPI Number | 1497481832
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Entity Type | Organization
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Legal Business Name | HOLIDAY ISLAND OPERATIONS, LLC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 89 HILLSIDE DR
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City | HOLIDAY ISLAND
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State | AR
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Zip | 72631-4658
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Country | US
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Telephone | 479-530-3779
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Fax |
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Provider Business Mailing Address
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Address Line | 89 HILLSIDE DR
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City | HOLIDAY ISLAND
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State | AR
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Zip | 72631-4658
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Country | US
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Telephone | 479-530-3779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND DENNINGTON MOSS
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Credential |
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Telephone | 479-530-3779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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