Healthcare Provider Details

I. General information

NPI: 1033618087
Provider Name (Legal Business Name): WHOLISTIC WELLNESS & HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311B MOORE AVE
POOLER GA
31322-2010
US

IV. Provider business mailing address

311B MOORE AVE
POOLER GA
31322-2010
US

V. Phone/Fax

Practice location:
  • Phone: 912-677-8167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RETHA WEBB
Title or Position: CEO
Credential:
Phone: 912-677-8167