Provider Demographics
NPI:1669778882
Name:HOLY HILL HOME CARE
Entity type:Organization
Organization Name:HOLY HILL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURACI
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:909-446-0296
Mailing Address - Street 1:33922 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2330
Mailing Address - Country:US
Mailing Address - Phone:909-446-0296
Mailing Address - Fax:909-447-0296
Practice Address - Street 1:33922 COLORADO ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2330
Practice Address - Country:US
Practice Address - Phone:909-446-0296
Practice Address - Fax:909-446-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366402904310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility