Provider Demographics
NPI:1831410059
Name:HOLISTIC HEALING CENTER
Entity type:Organization
Organization Name:HOLISTIC HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:305-919-7877
Mailing Address - Street 1:1590 NE 162ND ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4759
Mailing Address - Country:US
Mailing Address - Phone:305-919-7877
Mailing Address - Fax:305-945-6445
Practice Address - Street 1:1590 NE 162ND ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4759
Practice Address - Country:US
Practice Address - Phone:305-919-7877
Practice Address - Fax:305-945-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2201171100000X
FLMA20306225700000X
FLMA45064225700000X
FLMA49127225700000X
FLMA44408225700000X
FLMA39190225700000X
FLMA55297225700000X
FLAP682171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty