MEDICARE: DANA VIOLA HOLLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	30AL3591-A	MD

General Provider Information

NPI Number	:	1427651892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA VIOLA HOLLEY

Provider Business Mailing Address
First Line	:	821 W CROSS ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-2501
Country	:	US
Telephone Number	:	443-633-1768
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 W CROSS ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-2501
Country	:	US
Telephone Number	:	443-633-1768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ DANA VIOLA HOLLEY ” Practice Location

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