MEDICARE: THE HOLMES FAMILY PRODUCTS AND SERVICES, LLC

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1689342099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HOLMES FAMILY PRODUCTS AND SERVICES, LLC

Provider Business Mailing Address
First Line	:	4714 DERRY ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1317
Country	:	US
Telephone Number	:	678-478-7574
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 DERRY ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1317
Country	:	US
Telephone Number	:	678-478-7574
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER/ MEMBER
Name	:	MR. TERRY EUGENE HOLMES
Credential	:
Telephone Number	:	678-478-7574

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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