Healthcare Provider Details

I. General information

NPI: 1205580024
Provider Name (Legal Business Name): WHOLE ME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 JAMES ST
SYRACUSE NY
13203-2770
US

IV. Provider business mailing address

1010 JAMES ST
SYRACUSE NY
13203-2770
US

V. Phone/Fax

Practice location:
  • Phone: 315-468-3275
  • Fax: 315-468-3276
Mailing address:
  • Phone: 315-468-3275
  • Fax: 315-468-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIN E. MACK
Title or Position: DEPUTY DIRECTOR OF ADMINISTRATIVE S
Credential:
Phone: 315-468-3275