1578549978 NPI number — TOTAL HEALTH HOLISTIC CENTER, INC.

Table of content: (NPI 1578549978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578549978 NPI number — TOTAL HEALTH HOLISTIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL HEALTH HOLISTIC CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578549978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 HOLLAND RD APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01603-1858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-821-7054
Provider Business Mailing Address Fax Number:
774-208-0712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 HOLLAND RD APT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01603-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-821-7054
Provider Business Practice Location Address Fax Number:
774-208-0712
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ST.LAURENT
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-821-7054

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2269 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1612913 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4404288 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9228734 . This is a "PHCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 798431 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y36596 . This is a "BC/BS OF MA INDIVIDUAL ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 033487192 . This is a "HCVM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 27243 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1867401004 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2859278 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 974044 . This is a "NETWORK HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39715 . This is a "BC/BS OF MA GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 351902 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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