Provider Demographics
NPI:1093485336
Name:WHOLISTIC RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:WHOLISTIC RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:MATTHEW
Authorized Official - Suffix:
Authorized Official - Credentials:CPC-INTERN
Authorized Official - Phone:707-981-0289
Mailing Address - Street 1:2580 N RANCHO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3361
Mailing Address - Country:US
Mailing Address - Phone:702-981-0289
Mailing Address - Fax:
Practice Address - Street 1:2580 N RANCHO DR STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3361
Practice Address - Country:US
Practice Address - Phone:702-981-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty