HOLLOWOOD HOUSE NPI 1225045255

NPI Information

NPI: 1225045255
Provider Name: HOLLOWOOD HOUSE
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

CLIA Number: 36D0930435

Address:
3717 ALESIA KAE DR
BRUNSWICK, OH
ZIP 44212
Phone: (330) 273-5494
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HOLLOWOOD HOUSE is an intermediate care facility mentally retarded in Brunswick, OH. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. HOLLOWOOD HOUSE NPI is 1225045255. The provider is registered as an organization entity type.

The provider's business location address is:

3717 ALESIA KAE DR
BRUNSWICK, OH
ZIP 44212-012
Phone: (330) 273-5494
Fax: (330) 273-6199

The provider's authorized official is Denise T Pozderac .
The authorized official title is President/administrator and has the following contact phone number (330) 273-5494.

The CLIA number assigned to this NPI record is 36D0930435 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/2/2006 and was last updated on 7/12/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		5210284	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	36-G533	MEDICAID	OHIO
2	2015161	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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