# HOLLY CONVALESCENT CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Holly Convalescent Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225108418
- **Authorized official:** MR. DAVID HANEY (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (248) 634-9281

## Contact information

- **Practice address:** 313 SHERWOOD ST, HOLLY, MI 48442-1232
- **Practice address phone:** (248) 634-9281
- **Practice address fax:** (248) 634-9553
- **Mailing address:** 313 SHERWOOD ST, HOLLY, MI 48442-1232
- **Mailing address phone:** (248) 634-9281
- **Mailing address fax:** (248) 634-9553

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 63-4380 | MI | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 01/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 23E252 | — | MI |
| 01 | — | 63-4380 | STATE FACILITY NUMBER | MI |