NPIMap

Organization Active NPI

Holiday Island Operations, LLC

Doing business as Green Acre Lodge of Holiday Island

  • Assisted Living Facility
  • Holiday Island, AR
National Provider Identifier
1427444124
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
105 Issued in AR
Legal business name
HOLIDAY ISLAND OPERATIONS, LLC
Doing business as
Green Acre Lodge of Holiday Island
Practice address
89 Hillside Drive
Holiday Island, AR 72631
Phone
(479) 253-6553
Fax
(479) 253-5043
NPI assigned
Apr 9, 2015
Last updated
Apr 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

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

Authorized official

Name
Mr. Raymond Dennington Moss
Title
Manager
Phone
(479) 530-3779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 105 AR Primary

Addresses

Primary practice location

89 Hillside Drive
Holiday Island, AR 72631

Mailing address

89 Hillside Drive
Holiday Island, AR 72631
Phone (479) 253-6553

Other identifiers 1

IdentifierTypeStateIssuer
206460794MedicaidAR

Other names 1

  • Green Acre Lodge of Holiday Island Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Green Acre Lodge of Holiday Island2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1428537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1427444124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 HILLSIDE DRIVE",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "72631",
            "telephone_number": "479-253-6553",
            "fax_number": "479-253-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 HILLSIDE DRIVE",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "72631",
            "telephone_number": "479-253-6553",
            "fax_number": "479-253-5043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLIDAY ISLAND OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-09",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "DENNINGTON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "479-530-3779",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206460794",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Acre Lodge of Holiday Island",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holiday Island, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; 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.