Provider Demographics
NPI:1205642915
Name:ADULT & GERIATRIC WHOLISTIC HEALTH LLC
Entity type:Organization
Organization Name:ADULT & GERIATRIC WHOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-908-8136
Mailing Address - Street 1:647 S MARATHON WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5841
Mailing Address - Country:US
Mailing Address - Phone:832-908-8136
Mailing Address - Fax:
Practice Address - Street 1:647 S MARATHON WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5841
Practice Address - Country:US
Practice Address - Phone:832-908-8136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology