Hollybrook Care Facility

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

MHL 092-561 Issued in NC

Legal business name

HOLLYBROOK CARE FACILITY

Practice address

130 Harris Street
Wendell, NC 27591

Phone

(919) 961-7515

NPI assigned

Mar 21, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Lucille Cooper

Title

Owner

Phone

(919) 961-7515

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508982695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1375",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "275911375",
            "telephone_number": "919-961-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HARRIS STREET",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "27591",
            "telephone_number": "919-961-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLYBROOK CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "LUCILLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-961-7515",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL 092-561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804889",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Renita Harris, LCSW
• Deanna Harris, MD
• Sayed Abdul Rahman Hashemee, M.D.
• Mason Shelby Tyndall Hayslip, PA-C
• Heath B Brantley, DDS (Wendell Family Dentistry)
• Sara Guevara Howell
• Summer Hurst
• Chidinma Ifegwu
• Intime Transportation Services LLC
• Ronald S Intini, MD

• Adult Care Home Facility in Wendell, NC
• Providers in Wendell, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.