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Contact Information

A.G. HOLLEY STATE HOSPITAL
1199 LANTANA RD
LANTANA, FL33462-1514
 Phone: 561-540-3721
 Fax: 561-545-0372
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Institutional Pharmacy

3336I0012X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for A.G. HOLLEY STATE HOSPITAL

NPI # 1295811032
LBN Legal business name A.G. HOLLEY STATE HOSPITAL
Authorized official JERRY STAMBAUGH - (PHARMACIST)
Entity Organization
Organization subpart 1 No
Enumeration date 10/27/2006
Last updated 06/13/2008 - About 18 years ago
Identifiers
FL License # PH0016562
FL Medicaid 0215171-00
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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