Healthcare Provider Details

I. General information

NPI: 1639200355
Provider Name (Legal Business Name): WHOLISTIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6627 1ST ST NW
WASHINGTON DC
20012-2125
US

IV. Provider business mailing address

2309 VARNUM ST
MOUNT RAINIER MD
20712-1459
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-3049
  • Fax: 202-723-6446
Mailing address:
  • Phone: 202-832-8787
  • Fax: 202-347-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number025359800
License Number StateDC

VIII. Authorized Official

Name: MS. MIATTA N THOMAS
Title or Position: VICE PRESIDENT
Credential: ATTORNEY
Phone: 202-832-8787