Provider Demographics
NPI:1194712448
Name:THE WHOLISTIC CENTER FOR WELLNESS INC
Entity type:Organization
Organization Name:THE WHOLISTIC CENTER FOR WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NP CEO PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SANLVCCI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD RN APNC
Authorized Official - Phone:856-690-0627
Mailing Address - Street 1:1014 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2527
Mailing Address - Country:US
Mailing Address - Phone:856-690-0627
Mailing Address - Fax:856-690-0627
Practice Address - Street 1:1014 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2527
Practice Address - Country:US
Practice Address - Phone:856-690-0627
Practice Address - Fax:856-690-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
088413Medicare ID - Type Unspecified