Healthcare Provider Details

I. General information

NPI: 1700797826
Provider Name (Legal Business Name): WHOLENESS HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 E PROSPECT RD STE 150
FORT COLLINS CO
80525-9098
US

IV. Provider business mailing address

2620 E PROSPECT RD STE 150
FORT COLLINS CO
80525-9098
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANN GENDASZEK
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 303-489-9685