Provider Demographics
NPI:1003677998
Name:GRAND UNION HOLISTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:GRAND UNION HOLISTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-487-0003
Mailing Address - Street 1:1150 SOUTH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3404
Mailing Address - Country:US
Mailing Address - Phone:929-487-0003
Mailing Address - Fax:
Practice Address - Street 1:1150 SOUTH AVE STE 200
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3404
Practice Address - Country:US
Practice Address - Phone:929-487-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder