Provider Demographics
NPI:1639550700
Name:HOLISTIC HEALTH AND HUMAN SERVICES OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH AND HUMAN SERVICES OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:708-846-2091
Mailing Address - Street 1:1813 RIVERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1608
Mailing Address - Country:US
Mailing Address - Phone:708-846-2091
Mailing Address - Fax:
Practice Address - Street 1:1813 RIVERWOODS DR
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1608
Practice Address - Country:US
Practice Address - Phone:708-846-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health