Provider Demographics
NPI:1417334137
Name:HOLISTIC HEALTHCARE LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-458-5451
Mailing Address - Street 1:4630 ROBBINS GROVE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2840
Mailing Address - Country:US
Mailing Address - Phone:314-918-5736
Mailing Address - Fax:
Practice Address - Street 1:4630 ROBBINS GROVE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2840
Practice Address - Country:US
Practice Address - Phone:314-918-5736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000150468313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2000150468OtherRN