Elderly Living Center of Holly Hill, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

ELDERLY LIVING CENTER OF HOLLY HILL, INC

Practice address

810 Oleander Ave
Holly Hill, FL 32117-3434

Phone

(407) 810-7841

NPI assigned

Dec 14, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Dale Lucas

Title

President

Phone

(407) 810-7841

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1366210809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 OLEANDER AVE",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321173434",
            "telephone_number": "407-810-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 OLEANDER AVE",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321173434",
            "telephone_number": "407-810-7841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERLY LIVING CENTER OF HOLLY HILL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-14",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "LUCAS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-810-7841"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102518900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wayne S Downer, LMT
• Daniel E Drake, PAC
• Brandi Lee Driggers
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• Michael Scott Edwards
• Emergency Medical Foundation Inc
• Lambert Harold Everson, CNA
• Faithful Caregivers,LLC
• Family Medical Practice Management, Inc.
• John Nicholas Fedorovich, R.PH.

• Assisted Living Facility in Holly Hill, FL
• Providers in Holly Hill, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.