MEDICARE: HOLISTIC HEALING ARTS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1346332467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALING ARTS, LLC

Provider Business Mailing Address
First Line	:	2010 HICKORY RIDGE RD
Second Line	:
City	:	POMONA
State	:	IL
Zip	:	62975-2325
Country	:	US
Telephone Number	:	618-893-9150
Fax Number	:	618-893-1960

Provider Business Practice Location Address
First Line	:	2010 HICKORY RIDGE RD
Second Line	:
City	:	POMONA
State	:	IL
Zip	:	62975-2325
Country	:	US
Telephone Number	:	618-893-9150
Fax Number	:	618-893-1960

Authorized Official
Title or Position	:	OWNER / PORVIDER
Name	:	LINDA HOSTALEK
Credential	:	DO
Telephone Number	:	618-893-1950

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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