Provider Demographics
NPI:1790001154
Name:CENTERS FOR WHOLE HEALTH, LLC
Entity Type:Organization
Organization Name:CENTERS FOR WHOLE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-221-3923
Mailing Address - Street 1:2000 FORT BRAGG RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7041
Mailing Address - Country:US
Mailing Address - Phone:910-483-3334
Mailing Address - Fax:910-483-7606
Practice Address - Street 1:2000 FORT BRAGG RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7041
Practice Address - Country:US
Practice Address - Phone:910-483-3334
Practice Address - Fax:910-483-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42673261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ487672Medicaid
AZ487672Medicaid
AZZ138551Medicare Oscar/Certification