Healthcare Provider Details

I. General information

NPI: 1750710547
Provider Name (Legal Business Name): COMPREHENSIVE HOLISTIC HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26558 LAKEVIEW DR.
HELENDALE CA
92342-0641
US

IV. Provider business mailing address

PO BOX 641
HELENDALE CA
92342-0641
US

V. Phone/Fax

Practice location:
  • Phone: 909-213-1842
  • Fax:
Mailing address:
  • Phone: 909-213-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GAIL RENE DAVIS
Title or Position: DIRECTOR
Credential: RN
Phone: 909-213-1842