Provider Demographics
NPI:1699212050
Name:WHOLE HEALTH LIGHT
Entity Type:Organization
Organization Name:WHOLE HEALTH LIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED LIGHT THERAPY INSTRUCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELANEY
Authorized Official - Middle Name:BAUMANN
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:CBT, CLS, CLTI
Authorized Official - Phone:970-275-6603
Mailing Address - Street 1:302 W TOMICHI AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2708
Mailing Address - Country:US
Mailing Address - Phone:970-275-6603
Mailing Address - Fax:
Practice Address - Street 1:302 W TOMICHI AVE STE B
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2708
Practice Address - Country:US
Practice Address - Phone:970-275-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO302038332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies