MEDICARE: HOLISTIC CARE CONNECTIONS LLC

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	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251J00000X	OTHER	NY	NYC DEPT OF CONSUMER AFFAIRS

General Provider Information

NPI Number	:	1275130569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC CARE CONNECTIONS LLC

Provider Business Mailing Address
First Line	:	3632 KINGSBRIDGE AVE FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-2339
Country	:	US
Telephone Number	:	646-240-4888
Fax Number	:	718-601-4646

Provider Business Practice Location Address
First Line	:	3632 KINGSBRIDGE AVE FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-2339
Country	:	US
Telephone Number	:	646-240-4888
Fax Number	:	718-601-4646

Authorized Official
Title or Position	:	MANAGING PARTNER/CO-OWNER/COFOUNDER
Name	:	RICK GANG
Credential	:
Telephone Number	:	646-240-4888

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/12/2020

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