Provider Demographics
NPI:1629626445
Name:WHOLECARE WELLNESS LLC
Entity Type:Organization
Organization Name:WHOLECARE WELLNESS LLC
Other - Org Name:WHOLECARE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-797-1097
Mailing Address - Street 1:5390 PEACHTREE INDUSTRIAL BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1566
Mailing Address - Country:US
Mailing Address - Phone:404-797-1097
Mailing Address - Fax:
Practice Address - Street 1:5390 PEACHTREE INDUSTRIAL BLVD STE 130
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1566
Practice Address - Country:US
Practice Address - Phone:404-797-1097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA417006435JMedicaid
GA417006435GMedicaid