# HOLLYBROOK CARE FACILITY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508982695
- **Authorized official:** MRS. LUCILLE COOPER (OWNER)
- **Authorized official phone:** (919) 961-7515

## Contact information

- **Practice address:** 130 HARRIS STREET, WENDELL, NC 27591
- **Practice address phone:** (919) 961-7515
- **Mailing address:** PO BOX 1375, WENDELL, NC 27591-1375
- **Mailing address phone:** (919) 961-7515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | MHL 092-561 | NC | Yes |

## Other

- **Enumeration date:** 03/21/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7804889 | — | NC |