Provider Demographics
NPI:1396290326
Name:HOLISTICC HOME HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:HOLISTICC HOME HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGIRI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-285-2399
Mailing Address - Street 1:325 E BAYVIEW BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-5200
Mailing Address - Country:US
Mailing Address - Phone:757-285-2399
Mailing Address - Fax:
Practice Address - Street 1:325 E BAYVIEW BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-5200
Practice Address - Country:US
Practice Address - Phone:757-285-2399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health