Provider Demographics
NPI:1134701352
Name:HOLISTIC HEALTH AND MEDICAL CARE INC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH AND MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITONER
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:APN,FNP-C
Authorized Official - Phone:708-378-4971
Mailing Address - Street 1:20042 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1312
Mailing Address - Country:US
Mailing Address - Phone:708-378-4971
Mailing Address - Fax:
Practice Address - Street 1:20042 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-1312
Practice Address - Country:US
Practice Address - Phone:708-378-4971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL354646933001Medicaid