Provider Demographics
NPI:1871540070
Name:HOLLYWELL HEALTHCARE, LLC
Entity type:Organization
Organization Name:HOLLYWELL HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTH. PERSON/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:VENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-963-8800
Mailing Address - Street 1:975 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3056
Mailing Address - Country:US
Mailing Address - Phone:781-963-8800
Mailing Address - Fax:781-963-8922
Practice Address - Street 1:975 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3056
Practice Address - Country:US
Practice Address - Phone:781-963-8800
Practice Address - Fax:781-963-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0439314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928801Medicaid
225042Medicare ID - Type Unspecified