Healthcare Provider Details

I. General information

NPI: 1457277568
Provider Name (Legal Business Name): WHOLE HEARTED HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27483 DEQUINDRE RD SUITE 306
MADISON HEIGHTS MI
48071
US

IV. Provider business mailing address

21319 REIMANVILLE AVE
FERNDALE MI
48220-2231
US

V. Phone/Fax

Practice location:
  • Phone: 313-473-9140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMARIA HALL
Title or Position: OWNER
Credential:
Phone: 248-259-0461