Provider Demographics
NPI:1104901156
Name:HOLISTIC HEALTH MEDICAL CENTER
Entity type:Organization
Organization Name:HOLISTIC HEALTH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ALEVIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-223-3811
Mailing Address - Street 1:567 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2834
Mailing Address - Country:US
Mailing Address - Phone:985-223-3811
Mailing Address - Fax:
Practice Address - Street 1:567 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2834
Practice Address - Country:US
Practice Address - Phone:985-223-3811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1331111N00000X
LAACU.C10006171100000X
LAMD.10792R207V00000X
LAMD 023740208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CN60Medicare ID - Type Unspecified