Provider Demographics
NPI:1457788176
Name:HOLISTIC HEALTH LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BAYLISS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSN
Authorized Official - Phone:614-507-9604
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-0549
Mailing Address - Country:US
Mailing Address - Phone:614-507-9604
Mailing Address - Fax:
Practice Address - Street 1:4109 SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9031
Practice Address - Country:US
Practice Address - Phone:614-507-9604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 12022-NP251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage