Provider Demographics
NPI:1013769389
Name:HOLISTIC APPROACH DIRECT PRIMARY CARE CENTER LLC
Entity Type:Organization
Organization Name:HOLISTIC APPROACH DIRECT PRIMARY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-299-1230
Mailing Address - Street 1:501 BAY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2554
Mailing Address - Country:US
Mailing Address - Phone:609-299-1230
Mailing Address - Fax:
Practice Address - Street 1:501 BAY AVE STE 105
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2554
Practice Address - Country:US
Practice Address - Phone:609-299-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty