MEDICARE: WHOLESOME HEALTH 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1801542329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLESOME HEALTH LLC

Provider Business Mailing Address
First Line	:	4122 NORTH ST
Second Line	:
City	:	GRANVILLE
State	:	OH
Zip	:	43023-9772
Country	:	US
Telephone Number	:	440-313-8643
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 N 4TH ST
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-5009
Country	:	US
Telephone Number	:	740-641-6574
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MEGAN REED
Credential	:	NP
Telephone Number	:	440-313-8643

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	04/20/2023

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Directions to “WHOLESOME HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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