Provider Demographics
NPI:1508554742
Name:PRIMARY HOLISTIC CARE LLC
Entity Type:Organization
Organization Name:PRIMARY HOLISTIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:848-404-6717
Mailing Address - Street 1:531 TINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3211
Mailing Address - Country:US
Mailing Address - Phone:848-404-6717
Mailing Address - Fax:
Practice Address - Street 1:531 TINTON AVE
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3211
Practice Address - Country:US
Practice Address - Phone:848-404-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1548975840.OtherNEW JERSEY