MEDICARE: D. HOLMES RESIDENTIAL, INC.

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	AL10103	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952540627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D. HOLMES RESIDENTIAL, INC.

Provider Business Mailing Address
First Line	:	6809 LYMAN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610
Country	:	US
Telephone Number	:	813-231-7983
Fax Number	:	813-232-1916

Provider Business Practice Location Address
First Line	:	6809 LYMAN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610
Country	:	US
Telephone Number	:	813-231-7983
Fax Number	:	813-232-1916

Authorized Official
Title or Position	:	OWNER
Name	:	DELORES Y. HOLMES
Credential	:
Telephone Number	:	813-231-7983

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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