Provider Demographics
NPI:1174142053
Name:HOLLY GROVE HEALTH CARE LLC
Entity type:Organization
Organization Name:HOLLY GROVE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-322-9117
Mailing Address - Street 1:227 E SUNSHINE ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2652
Mailing Address - Country:US
Mailing Address - Phone:417-322-9117
Mailing Address - Fax:417-708-4654
Practice Address - Street 1:227 E SUNSHINE ST STE 6
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2652
Practice Address - Country:US
Practice Address - Phone:417-322-9117
Practice Address - Fax:417-708-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health