Healthcare Provider Details

I. General information

NPI: 1720523541
Provider Name (Legal Business Name): HOLISTIC HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 11/19/2023
Certification Date: 11/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 KINDERKAMACK RD STE 124
ORADELL NJ
07649-1500
US

IV. Provider business mailing address

712 PARAMUS RD
PARAMUS NJ
07652-1735
US

V. Phone/Fax

Practice location:
  • Phone: 201-400-7292
  • Fax: 866-889-7073
Mailing address:
  • Phone: 201-400-7292
  • Fax: 888-599-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNNO71590
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNNO71590
License Number StateNH

VIII. Authorized Official

Name: MS. SANTA J CRISALL
Title or Position: PRESIDENT
Credential: RN,APN, PSYD
Phone: 201-400-7292