Provider Demographics
NPI:1073931606
Name:HOLISTIC HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:HOLISTIC HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:YATTA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-995-2533
Mailing Address - Street 1:1156 MAIN ST STE 2R
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6833
Mailing Address - Country:US
Mailing Address - Phone:978-995-2533
Mailing Address - Fax:978-649-6270
Practice Address - Street 1:1156 MAIN ST
Practice Address - Street 2:SUITE 2R
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:978-995-2533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health