Provider Demographics
NPI:1932940574
Name:MOSS HOLLAND ENTERPRISES LLC
Entity type:Organization
Organization Name:MOSS HOLLAND ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-447-1959
Mailing Address - Street 1:4210 FOREST DALE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4610
Mailing Address - Country:US
Mailing Address - Phone:803-447-1959
Mailing Address - Fax:
Practice Address - Street 1:18377 WESTINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-7933
Practice Address - Country:US
Practice Address - Phone:276-676-3468
Practice Address - Fax:276-451-0175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSS HOLLAND ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion