Provider Demographics
NPI:1285109561
Name:WHOLE SELF RECOVERY
Entity type:Organization
Organization Name:WHOLE SELF RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-920-6020
Mailing Address - Street 1:PO BOX 4621
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-4621
Mailing Address - Country:US
Mailing Address - Phone:505-920-6020
Mailing Address - Fax:505-367-0077
Practice Address - Street 1:509 W PUEBLO DR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2508
Practice Address - Country:US
Practice Address - Phone:506-747-3368
Practice Address - Fax:505-367-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center