Provider Demographics
NPI:1972054989
Name:HOLIDAY AL NIC MANAGEMENT LLC
Entity type:Organization
Organization Name:HOLIDAY AL NIC MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARALEGAL FOR MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-245-8020
Mailing Address - Street 1:5885 MEADOWS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8639
Mailing Address - Country:US
Mailing Address - Phone:971-245-8020
Mailing Address - Fax:
Practice Address - Street 1:5885 MEADOWS RD
Practice Address - Street 2:SUITE 500
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8639
Practice Address - Country:US
Practice Address - Phone:971-245-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009421900Medicaid
FL009507900Medicaid
FL009793200Medicaid
FL009793400Medicaid
FL009788900Medicaid
FL009091600Medicaid
FL009789900Medicaid
FL009794200Medicaid
NC7805631Medicaid
FL009023200Medicaid
FL009678900Medicaid
FL009790400Medicaid
NC7805634Medicaid
FL009196100Medicaid
FL009794700Medicaid
FL009792400Medicaid