Provider Demographics
NPI:1407226434
Name:HOLISTIX OUTPATIENT CENTER
Entity Type:Organization
Organization Name:HOLISTIX OUTPATIENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COCCIA
Authorized Official - Suffix:III
Authorized Official - Credentials:CEO
Authorized Official - Phone:856-889-0617
Mailing Address - Street 1:2300 S BROAD ST
Mailing Address - Street 2:STE 202-203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4461
Mailing Address - Country:US
Mailing Address - Phone:856-889-0617
Mailing Address - Fax:
Practice Address - Street 1:2300 S BROAD ST
Practice Address - Street 2:STE 202-203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4461
Practice Address - Country:US
Practice Address - Phone:856-889-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder