=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093609893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC HEALTH CODE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1051 FARMINGTON AVE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-940-0900
-----------------------------------------------------
Fax | 860-253-2898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1051 FARMINGTON AVE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-940-0900
-----------------------------------------------------
Fax | 860-253-2898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE MANAGER
-----------------------------------------------------
Name | ARLENE BURNS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 860-940-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------