1538787098 NPI number — HOLISTIC PRIMARY CARE & BEHAVIORAL HEALTH SERVICES

Table of content: (NPI 1538787098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538787098 NPI number — HOLISTIC PRIMARY CARE & BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC PRIMARY CARE & BEHAVIORAL HEALTH SERVICES
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:
6
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:
1538787098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 VICTOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08002-4424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-932-6264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 HADDONFIELD RD # 358
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08002-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-565-8052
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FELIX
Authorized Official First Name:
SYLVIE
Authorized Official Middle Name:
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
185-643-8676

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1124646674 . This is a "PRIMARY CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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