Provider Demographics
NPI:1154924769
Name:HOLLAND, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 TREE MOSS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2553
Mailing Address - Country:US
Mailing Address - Phone:440-454-3289
Mailing Address - Fax:
Practice Address - Street 1:5663 TREE MOSS LN
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2553
Practice Address - Country:US
Practice Address - Phone:440-454-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider