Provider Demographics
NPI:1932072196
Name:HOLLIS HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:HOLLIS HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEDRICK
Authorized Official - Middle Name:LLEWELLYN
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-421-4903
Mailing Address - Street 1:2402 SEQUOYA DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-2764
Mailing Address - Country:US
Mailing Address - Phone:765-421-4903
Mailing Address - Fax:
Practice Address - Street 1:2402 SEQUOYA DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2764
Practice Address - Country:US
Practice Address - Phone:765-421-4903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health