Provider Demographics
NPI:1760883631
Name:WHOLE-ISTIC LIVING LLC
Entity Type:Organization
Organization Name:WHOLE-ISTIC LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLPE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:781-864-4285
Mailing Address - Street 1:10 CEDAR ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CEDAR ST
Practice Address - Street 2:SUITE 24
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6364
Practice Address - Country:US
Practice Address - Phone:781-864-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3475261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service