MEDICARE: HOLISTIC TRANSITIONS HEALTHCARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1902482813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC TRANSITIONS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	5219 WADENA ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55807-2634
Country	:	US
Telephone Number	:	952-994-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	5219 WADENA ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55807-2634
Country	:	US
Telephone Number	:	952-994-6469
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIANNA ROSE QUINN
Credential	:
Telephone Number	:	715-817-6345

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	03/22/2021

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