Provider Demographics
NPI:1497819593
Name:PROVIDENCE WHOLISTIC HEALTHCARE
Entity Type:Organization
Organization Name:PROVIDENCE WHOLISTIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SENG
Authorized Official - Suffix:
Authorized Official - Credentials:DA, LAC
Authorized Official - Phone:401-455-0546
Mailing Address - Street 1:PO BOX 2424
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-455-0546
Mailing Address - Fax:401-751-4165
Practice Address - Street 1:144 WATERMAN STREET
Practice Address - Street 2:SUITE #3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-455-0546
Practice Address - Fax:401-751-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRIDA00153171100000X
MAMA203351171100000X
OROR949175F00000X
CTCT214175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty