Provider Demographics
NPI:1093470668
Name:HOLISTIQUE PRIMARY CARE LLC
Entity Type:Organization
Organization Name:HOLISTIQUE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAHANSHAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DARVISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-321-2202
Mailing Address - Street 1:1200 116TH AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3802
Mailing Address - Country:US
Mailing Address - Phone:425-451-0404
Mailing Address - Fax:425-462-8919
Practice Address - Street 1:1200 116TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3802
Practice Address - Country:US
Practice Address - Phone:425-451-0404
Practice Address - Fax:425-462-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care