Provider Demographics
NPI:1184861536
Name:WHOLISTIC SERVICES, X INC.
Entity Type:Organization
Organization Name:WHOLISTIC SERVICES, X INC.
Other - Org Name:WHOLISTIC SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-347-2165
Mailing Address - Street 1:1221 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-5302
Mailing Address - Country:US
Mailing Address - Phone:202-347-5334
Mailing Address - Fax:202-347-1916
Practice Address - Street 1:1419 VAN BUREN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2833
Practice Address - Country:US
Practice Address - Phone:202-347-2165
Practice Address - Fax:202-347-1916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHOLISTIC SERVICES, X INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-07
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC=========Medicaid