Provider Demographics
NPI:1659602787
Name:HOLISTIC HEALING SYSTEM LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALING SYSTEM LLC
Other - Org Name:REALITY HOUSING FUND
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:212-996-5899
Mailing Address - Street 1:127 E 105TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4917
Mailing Address - Country:US
Mailing Address - Phone:212-289-1004
Mailing Address - Fax:212-987-2787
Practice Address - Street 1:206 E 117TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4862
Practice Address - Country:US
Practice Address - Phone:212-996-5899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20628171M00000X
NY203118208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty