Provider Demographics
NPI:1588802763
Name:ILLNESS PREVENTION AND HOLISTIC HEALTH CENTER
Entity Type:Organization
Organization Name:ILLNESS PREVENTION AND HOLISTIC HEALTH CENTER
Other - Org Name:HOLISTIC SURGICAL ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUCCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-228-8012
Mailing Address - Street 1:545 WEST MARKET STREET
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801
Mailing Address - Country:US
Mailing Address - Phone:419-331-2225
Mailing Address - Fax:
Practice Address - Street 1:545 WEST MARKET STREET
Practice Address - Street 2:SUITE 306
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-331-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty