Provider Demographics
NPI: | 1275009094 |
---|---|
Name: | LIVING WHOLEY, INC. |
Entity Type: | Organization |
Organization Name: | LIVING WHOLEY, INC. |
Other - Org Name: | PATH OF LIFE HEALING CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CLINICAL NUTRITIONIST |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | VENETTA |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | KALU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LDN, CNS, ND |
Authorized Official - Phone: | 301-377-4523 |
Mailing Address - Street 1: | 4600 POWDER MILL RD # 450-K |
Mailing Address - Street 2: | |
Mailing Address - City: | BELTSVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20705-2675 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-267-3136 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4600 POWDER MILL RD # 450-K |
Practice Address - Street 2: | |
Practice Address - City: | BELTSVILLE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20705-2675 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-267-3136 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-10-18 |
Last Update Date: | 2020-08-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Single Specialty |