Healthcare Provider Details

I. General information

NPI: 1508476219
Provider Name (Legal Business Name): HEAT HOLISTIC LIFESTYLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 SIMPSON AVE
NATIONAL PARK NJ
08063-1441
US

IV. Provider business mailing address

1109 SIMPSON AVE
NATIONAL PARK NJ
08063-1441
US

V. Phone/Fax

Practice location:
  • Phone: 856-870-9501
  • Fax: 856-329-9062
Mailing address:
  • Phone: 856-870-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICIA JOHNSON
Title or Position: CEO/OWNER
Credential:
Phone: 856-870-9501