Provider Demographics
NPI:1417690926
Name:WHOLE MISSION LLC
Entity Type:Organization
Organization Name:WHOLE MISSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:II
Authorized Official - Credentials:LLP
Authorized Official - Phone:313-969-7750
Mailing Address - Street 1:930 BEECHMONT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1513
Mailing Address - Country:US
Mailing Address - Phone:313-969-7750
Mailing Address - Fax:
Practice Address - Street 1:930 BEECHMONT ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1513
Practice Address - Country:US
Practice Address - Phone:313-969-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health