=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619164530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2007
-----------------------------------------------------
Last Update Date | 09/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 W OAKLAND PARK BLVD
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-714-0061
-----------------------------------------------------
Fax | 954-714-0062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 W OAKLAND PARK BLVD
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-714-0061
-----------------------------------------------------
Fax | 954-714-0062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. ETHLINE MAIS
-----------------------------------------------------
Credential | MSN
-----------------------------------------------------
Telephone | 954-714-0061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299991209
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------