Healthcare Provider Details

I. General information

NPI: 1104681915
Provider Name (Legal Business Name): HOLISTIC HARMONY HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9324 W VEREDA SOLANA DR
PEORIA AZ
85383-2209
US

IV. Provider business mailing address

9324 W VEREDA SOLANA DR
PEORIA AZ
85383-2209
US

V. Phone/Fax

Practice location:
  • Phone: 602-326-7460
  • Fax:
Mailing address:
  • Phone: 602-326-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HILARY NGUYEN
Title or Position: OWNER
Credential:
Phone: 602-326-7460