Provider Demographics
NPI:1861652877
Name:CENTER FOR HOLISTIC HEALTH LLC
Entity Type:Organization
Organization Name:CENTER FOR HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:H
Authorized Official - Last Name:POLASKY
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-298-7371
Mailing Address - Street 1:PO BOX 14695
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-4695
Mailing Address - Country:US
Mailing Address - Phone:505-298-7371
Mailing Address - Fax:505-298-7326
Practice Address - Street 1:1000 EUBANK BLVD. NE
Practice Address - Street 2:SUITE H
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2878
Practice Address - Country:US
Practice Address - Phone:505-298-7371
Practice Address - Fax:505-298-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM161RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02-085135-00-9OtherNM CRS