Provider Demographics
NPI:1689325862
Name:HEATHERS HOLISTICS
Entity Type:Organization
Organization Name:HEATHERS HOLISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-585-4333
Mailing Address - Street 1:17888 MUD SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5239
Mailing Address - Country:US
Mailing Address - Phone:208-585-4333
Mailing Address - Fax:
Practice Address - Street 1:3207 E USTICK RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6523
Practice Address - Country:US
Practice Address - Phone:208-585-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health