Organization Name: | HOLBROCK VENTURES LLC |
NPI Number: | 1023431830 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VERNON HOLMES (CEO) |
Mailing Address: | 9808 Tribonian Dr Fort Washington |
State: | MD US |
Postal Code: | 207445422 |
Phone Number: | 8003818671 |
Fax Number: | 8882551449 |
NPI Enumeration Date: | 01/30/2014 |
NPI Last Update Date: | 01/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |