MEDICARE: HOLISTIC HEALTH CARE MANAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	314000000X	Skilled Nursing Facility
3	3140N1450X	Pediatric Skilled Nursing Facility
4	3104A0625X	Assisted Living Facility (Mental Illness)
5	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
6	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
7	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
8	324500000X	Substance Abuse Rehabilitation Facility
9	3245S0500X	Children's Substance Abuse Rehabilitation Facility
10	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
11	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
12	320700000X	Physical Disabilities Residential Treatment Facility
13	313M00000X	Nursing Facility/Intermediate Care Facility
14	208D00000X	General Practice Physician
15	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1083092456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALTH CARE MANAGEMENT

Provider Business Mailing Address
First Line	:	3465 NW 43RD PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4240
Country	:	US
Telephone Number	:	954-625-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	3465 NW 43RD PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4240
Country	:	US
Telephone Number	:	954-625-4772
Fax Number	:

Authorized Official
Title or Position	:	TRUSTEE
Name	:	MARSHA THOMPSON
Credential	:	REGISTERED NURSE
Telephone Number	:	954-625-4772

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	05/18/2015

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