Healthcare Provider Details

I. General information

NPI: 1962896720
Provider Name (Legal Business Name): HOLISTIC WELLNESS ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/22/2021
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S ALMA SCHOOL RD
MESA AZ
85210-1011
US

IV. Provider business mailing address

11145 E SOMBRA AVE
MESA AZ
85212-5200
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-4644
  • Fax: 480-999-4622
Mailing address:
  • Phone: 480-999-4644
  • Fax: 480-999-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier76919
Identifier TypeOTHER
Identifier State
Identifier IssuerACHC ACCREDITATION AOID
# 2
IdentifierHHA9448
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerARIZONA DEPARTMENT OF HEALTH

VIII. Authorized Official

Name: STARLA LUCILLE MILLER
Title or Position: DIRECTOR OF CLINICAL OPERATIONS
Credential: RN
Phone: 480-999-4644