MEDICARE: WHOLISTIC HOME CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	385H00000X	Respite Care
4	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1346989183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC HOME CARE

Provider Business Mailing Address
First Line	:	8401 SOUTHSIDE BLVD APT 922
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-1605
Country	:	US
Telephone Number	:	904-758-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 SOUTHSIDE BLVD APT 922
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-1605
Country	:	US
Telephone Number	:	904-758-1503
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAHESIA S MCKNIGHT-CURRY
Credential	:
Telephone Number	:	904-758-1503

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “WHOLISTIC HOME CARE ” Practice Location

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