Provider Demographics
NPI:1164754420
Name:LEHIGH HOLISTIC CENTER
Entity Type:Organization
Organization Name:LEHIGH HOLISTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:BONOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-369-0000
Mailing Address - Street 1:228 PLAZA DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6054
Mailing Address - Country:US
Mailing Address - Phone:239-369-0000
Mailing Address - Fax:239-369-1420
Practice Address - Street 1:228 PLAZA DR
Practice Address - Street 2:UNIT C
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6054
Practice Address - Country:US
Practice Address - Phone:239-369-0000
Practice Address - Fax:239-369-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM24165305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service