Healthcare Provider Details

I. General information

NPI: 1922879352
Provider Name (Legal Business Name): WHOLEHEALTH ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CONTINENTAL BLVD STE 600
EL SEGUNDO CA
90245-5074
US

IV. Provider business mailing address

10866 WASHINGTON BLVD # 854
CULVER CITY CA
90232-3610
US

V. Phone/Fax

Practice location:
  • Phone: 310-528-8002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. PERNELL RAY JONES
Title or Position: PRESIDENT
Credential:
Phone: 310-528-8002