MEDICARE: HOLISTIC SERVICES INC

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	251S00000X	Community/Behavioral Health Agency	MHL-041-1041	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376824730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC SERVICES INC

Provider Business Mailing Address
First Line	:	1405 YANCEYVILLE ST
Second Line	:	SUITE E
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6938
Country	:	US
Telephone Number	:	336-333-2559
Fax Number	:	336-333-2578

Provider Business Practice Location Address
First Line	:	1405 YANCEYVILLE ST
Second Line	:	SUITE E
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6938
Country	:	US
Telephone Number	:	336-333-2559
Fax Number	:	336-333-2578

Authorized Official
Title or Position	:	CEO
Name	:	KIA MCLEAN
Credential	:
Telephone Number	:	336-258-1532

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	08/30/2011

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Directions to “HOLISTIC SERVICES INC ” Practice Location

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