Provider Demographics
NPI:1689135964
Name:HOLISTIC HEALTH & DETOX CENTER, LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH & DETOX CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUJII
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-450-4776
Mailing Address - Street 1:2016 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2430
Mailing Address - Country:US
Mailing Address - Phone:765-450-4776
Mailing Address - Fax:765-450-4776
Practice Address - Street 1:2016 S ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2430
Practice Address - Country:US
Practice Address - Phone:765-450-4776
Practice Address - Fax:765-450-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty