MEDICARE: HOLY HILL HOME CARE

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	366402904	CA

General Provider Information

NPI Number	:	1669778882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY HILL HOME CARE

Provider Business Mailing Address
First Line	:	33922 COLORADO ST
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-2330
Country	:	US
Telephone Number	:	909-446-0296
Fax Number	:	909-447-0296

Provider Business Practice Location Address
First Line	:	33922 COLORADO ST
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-2330
Country	:	US
Telephone Number	:	909-446-0296
Fax Number	:	909-446-0296

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARIA PURACI
Credential	:	LVN
Telephone Number	:	909-446-0296

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	01/11/2012

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