Provider Demographics
NPI:1689465544
Name:COUNTRY HOLISTICS LLC
Entity type:Organization
Organization Name:COUNTRY HOLISTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:307-429-9005
Mailing Address - Street 1:812 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5126
Mailing Address - Country:US
Mailing Address - Phone:307-429-9005
Mailing Address - Fax:
Practice Address - Street 1:39 N SCOTT ST STE 3
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6363
Practice Address - Country:US
Practice Address - Phone:307-429-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty