Provider Demographics
NPI:1275339632
Name:HALL-SAMPLE HOLISTIC GROUP, LLC
Entity type:Organization
Organization Name:HALL-SAMPLE HOLISTIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LANEEN
Authorized Official - Middle Name:SHANELLE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:757-709-5229
Mailing Address - Street 1:821 WHITE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-9589
Mailing Address - Country:US
Mailing Address - Phone:757-709-5229
Mailing Address - Fax:
Practice Address - Street 1:23472 JOHN CANE RD
Practice Address - Street 2:
Practice Address - City:GREENBUSH
Practice Address - State:VA
Practice Address - Zip Code:23357-2242
Practice Address - Country:US
Practice Address - Phone:757-709-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty