Healthcare Provider Details

I. General information

NPI: 1730713454
Provider Name (Legal Business Name): WHOLE LIFE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 E STATE ST
HERMITAGE PA
16148-1824
US

IV. Provider business mailing address

1565 E STATE ST
HERMITAGE PA
16148-1824
US

V. Phone/Fax

Practice location:
  • Phone: 724-347-5595
  • Fax: 724-347-5596
Mailing address:
  • Phone: 724-347-5595
  • Fax: 724-347-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CINDY VOGAN
Title or Position: CEO
Credential:
Phone: 724-347-5595