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General NPI Number Information
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NPI Number | 1366093825
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Entity Type | Organization
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Legal Business Name | HOLISTIC LIVING CENTER, LLC
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 950 N WASHINGTON ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1534
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Country | US
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Telephone | 240-758-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 620 E ROYAL OAKS DR
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City | MARLIN
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State | TX
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Zip | 76661-2225
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Country | US
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Telephone | 832-434-1029
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GRACE SEMPLE-PAUL
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Credential |
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Telephone | 832-434-1029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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