Healthcare Provider Details

I. General information

NPI: 1437480761
Provider Name (Legal Business Name): HOLISTIC HEALTH SERVICE OF NE OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 RICHMOND RD
RICHMOND HEIGHTS OH
44143-1407
US

IV. Provider business mailing address

250 RICHMOND RD
RICHMOND HEIGHTS OH
44143-1407
US

V. Phone/Fax

Practice location:
  • Phone: 216-556-0604
  • Fax:
Mailing address:
  • Phone: 216-556-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP03562
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberRN179386
License Number StateOH

VIII. Authorized Official

Name: NANCY S DALE
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 216-556-0604