MEDICARE: HOLISTIC HEALING HOME HEALTH 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1841951738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALING HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	23043 COLUMBIA ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3435
Country	:	US
Telephone Number	:	313-310-9151
Fax Number	:	313-447-2777

Provider Business Practice Location Address
First Line	:	23043 COLUMBIA ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3435
Country	:	US
Telephone Number	:	313-310-9151
Fax Number	:	313-447-2777

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	SARA HAWILY
Credential	:
Telephone Number	:	313-310-9151

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	06/13/2022

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