MEDICARE: WHOLISTIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		DC

General Provider Information

NPI Number	:	1134250806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	1221 MASSACHUSETTS AVE NW
Second Line	:	SUITE 1
City	:	WASHINGTON
State	:	DC
Zip	:	20005-5302
Country	:	US
Telephone Number	:	202-347-5334
Fax Number	:	202-347-1916

Provider Business Practice Location Address
First Line	:	1600 FRANKLIN ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2032
Country	:	US
Telephone Number	:	202-529-4100
Fax Number	:	202-529-6595

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. MIATTA N. THOMAS
Credential	:	ATTORNEY
Telephone Number	:	202-347-5334

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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