Organization
ELDERLY LIVING CENTER OF HOLLY HILL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY DALE LUCAS (PRESIDENT)
(407) 810-7841
Entity
Organization
Contact information
Practice address
810 OLEANDER AVE, HOLLY HILL, FL 32117-3434
(407) 810-7841
Mailing address
810 OLEANDER AVE, HOLLY HILL, FL 32117-3434
(407) 810-7841
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102518900
—
FL
Enumeration date
12/14/2023
Last updated
12/18/2023
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