Provider Demographics
NPI:1164931440
Name:HOLISTIX OUTPATIENT CENTER
Entity Type:Organization
Organization Name:HOLISTIX OUTPATIENT CENTER
Other - Org Name:HOLISTIX TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-676-2792
Mailing Address - Street 1:219 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 E HIGH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1101
Practice Address - Country:US
Practice Address - Phone:561-676-2792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLISTIX OUTPATIENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility