=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245843804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2020
-----------------------------------------------------
Last Update Date | 09/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1024 CANE BRANCH RD
-----------------------------------------------------
City | WALTERBORO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29488-0802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-670-5086
-----------------------------------------------------
Fax | 843-538-2837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1024 CANE BRANCH RD
-----------------------------------------------------
City | WALTERBORO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29488-0802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-915-4211
-----------------------------------------------------
Fax | 843-538-2837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | AL BERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-915-4211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------