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NPI Code Detail

MEDICARE: HOLISTIC HAVEN L.L.C.

MEDICARE: HOLISTIC HAVEN L.L.C.
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1477449692
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOLISTIC HAVEN L.L.C.
Provider Business Mailing Address
First Line : 213 W INSTITUTE PL STE 500
Second Line :
City : CHICAGO
State : IL
Zip : 60610-8792
Country : US
Telephone Number : 773-923-3103
Fax Number : 773-200-3820
Provider Business Practice Location Address
First Line : 213 W INSTITUTE PL STE 500
Second Line :
City : CHICAGO
State : IL
Zip : 60610-8792
Country : US
Telephone Number : 773-923-3103
Fax Number : 773-200-3820
Authorized Official
Title or Position : OWNER
Name : CRYSTAL GOODS
Credential : PMHNP
Telephone Number : 773-923-3103
Provider Enumeration Date : 06/16/2025
Last Update Date : 03/14/2026

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