=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821210022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLY HILL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14732 BENFIELD AVE
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-5609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-863-5490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14732 BENFIELD AVE
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-5609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-863-5490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ED FRANCISCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-841-9082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------