Provider Demographics
NPI:1366093825
Name:HOLISTIC LIVING CENTER, LLC
Entity type:Organization
Organization Name:HOLISTIC LIVING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMPLE-PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-434-1029
Mailing Address - Street 1:620 E ROYAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-2225
Mailing Address - Country:US
Mailing Address - Phone:832-434-1029
Mailing Address - Fax:
Practice Address - Street 1:950 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1534
Practice Address - Country:US
Practice Address - Phone:240-758-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health