Provider Demographics
NPI:1215053269
Name:CHERI LISA HOLMES
Entity type:Organization
Organization Name:CHERI LISA HOLMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:828-669-8501
Mailing Address - Street 1:32 CATON PL
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3259
Mailing Address - Country:US
Mailing Address - Phone:828-669-8501
Mailing Address - Fax:
Practice Address - Street 1:32 CATON PL
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3259
Practice Address - Country:US
Practice Address - Phone:828-669-8501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409316Medicaid