Provider Demographics
NPI:1720523541
Name:HOLISTIC HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTHCARE SERVICES, LLC
Other - Org Name:RESTORATIVE WELLNESS , LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRISALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,APN, PSYD
Authorized Official - Phone:201-400-7292
Mailing Address - Street 1:712 PARAMUS RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1735
Mailing Address - Country:US
Mailing Address - Phone:201-400-7292
Mailing Address - Fax:888-599-1771
Practice Address - Street 1:550 KINDERKAMACK RD STE 124
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1500
Practice Address - Country:US
Practice Address - Phone:201-400-7292
Practice Address - Fax:866-889-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNNO71590363LG0600X
NHNNO71590363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043608OtherMEDICARE
NJ8459908Medicaid
NJP18679Medicare UPIN