Healthcare Provider Details

I. General information

NPI: 1942600986
Provider Name (Legal Business Name): WHOLISTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 ANACOSTIA AVE NE
WASHINGTON DC
20019-1927
US

IV. Provider business mailing address

680 RHODE ISLAND AVE NE SUITE G1
WASHINGTON DC
20002-1269
US

V. Phone/Fax

Practice location:
  • Phone: 202-347-5334
  • Fax: 202-347-1916
Mailing address:
  • Phone: 202-832-8787
  • Fax: 202-832-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MIATTA THOMAS
Title or Position: VICE PRESIDENT
Credential:
Phone: 202-347-5334