MEDICARE: HOLLYWOOD HEALTH SERVICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	347C00000X	Private Vehicle
2	261QH0100X	Health Service Clinic/Center
3	261QH0700X	Hearing and Speech Clinic/Center
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	332BD1200X	Dialysis Equipment & Supplies (DME)
6	332U00000X	Home Delivered Meals
7	343900000X	Non-emergency Medical Transport (VAN)
8	251J00000X	Nursing Care Agency
9	251S00000X	Community/Behavioral Health Agency
10	261QA0600X	Adult Day Care Clinic/Center
11	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1912428335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD HEALTH SERVICE

Provider Business Mailing Address
First Line	:	2835 HOLLYWOOD AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-3864
Country	:	US
Telephone Number	:	318-402-9069
Fax Number	:	318-861-5069

Provider Business Practice Location Address
First Line	:	2835 HOLLYWOOD AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-3864
Country	:	US
Telephone Number	:	318-402-9069
Fax Number	:	318-861-5069

Authorized Official
Title or Position	:	OPERATIONAL DIRECTOR
Name	:	MR. TIMOTHY RENE THOMAS
Credential	:
Telephone Number	:	318-402-9069

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	01/29/2020

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Directions to “HOLLYWOOD HEALTH SERVICE ” Practice Location

Language	Start Address	Practice Location

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