Provider Demographics
NPI:1780224295
Name:PEDIATRIC HOLISTIC WELLNESS
Entity Type:Organization
Organization Name:PEDIATRIC HOLISTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-510-5302
Mailing Address - Street 1:635 SOUTHPOINTE CT STE 145
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3877
Mailing Address - Country:US
Mailing Address - Phone:719-510-5302
Mailing Address - Fax:
Practice Address - Street 1:635 SOUTHPOINTE CT STE 145
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3877
Practice Address - Country:US
Practice Address - Phone:719-510-5302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty