MEDICARE: HOLLYHOMECARELLC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1679253850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYHOMECARELLC

Provider Business Mailing Address
First Line	:	3221 ROUTE STE 200
Second Line	:
City	:	MOUNT LAUREL
State	:	PA
Zip	:	08054
Country	:	US
Telephone Number	:	180-698-5038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 ROUTE 38 STE 200
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-9765
Country	:	US
Telephone Number	:	800-698-5038
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHARI NICOLE BOOKER HOLLY
Credential	:
Telephone Number	:	215-221-2597

Provider Enumeration Date	:	07/21/2023
Last Update Date	:	05/18/2026

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