Healthcare Provider Details

I. General information

NPI: 1639670433
Provider Name (Legal Business Name): OCCEUS HOLISTIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 ROBIN HOOD DR
HINESVILLE GA
31313
US

IV. Provider business mailing address

734 ROBIN HOOD DR
HINESVILLE GA
31313-3985
US

V. Phone/Fax

Practice location:
  • Phone: 239-738-8688
  • Fax:
Mailing address:
  • Phone: 239-738-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberPCH003426
License Number StateGA

VIII. Authorized Official

Name: KERLLANNE OCCEUS
Title or Position: OWNER
Credential: RN
Phone: 239-738-8688