Organization
HOLLYBROOK CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUCILLE COOPER (OWNER)
(919) 961-7515
Entity
Organization
Contact information
Practice address
130 HARRIS STREET, WENDELL, NC 27591
(919) 961-7515
Mailing address
PO BOX 1375, WENDELL, NC 27591-1375
(919) 961-7515
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
MHL 092-561
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804889
—
NC
Enumeration date
03/21/2007
Last updated
08/22/2020
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