Provider Demographics
NPI:1649991266
Name:HOLISTIC MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:HOLISTIC MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAESAR
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, PMH-BC
Authorized Official - Phone:240-301-0237
Mailing Address - Street 1:14817 ROSE TRELLIS PL
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5738
Mailing Address - Country:US
Mailing Address - Phone:202-375-4367
Mailing Address - Fax:
Practice Address - Street 1:5801 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2608
Practice Address - Country:US
Practice Address - Phone:240-601-0237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD579012300Medicaid