Provider Demographics
NPI:1346432358
Name:HOLISTIC TECHNOLOGIES ENTERPRISE INC.
Entity Type:Organization
Organization Name:HOLISTIC TECHNOLOGIES ENTERPRISE INC.
Other - Org Name:DIVINE PHYSICS HOLISTIC LIFESTYLES & REGENERATION, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-221-0106
Mailing Address - Street 1:6500 S QUEBEC ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4673
Mailing Address - Country:US
Mailing Address - Phone:303-221-0106
Mailing Address - Fax:303-221-0107
Practice Address - Street 1:6500 S QUEBEC ST STE 200
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4673
Practice Address - Country:US
Practice Address - Phone:303-221-0106
Practice Address - Fax:303-221-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20041202740261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center