Provider Demographics
NPI:1386140184
Name:GRAND RISING HOLISTIC WELLNESS CENTER
Entity type:Organization
Organization Name:GRAND RISING HOLISTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATURAL HEALTH PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:352-872-6024
Mailing Address - Street 1:19670 SW EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-3650
Mailing Address - Country:US
Mailing Address - Phone:352-872-6024
Mailing Address - Fax:
Practice Address - Street 1:19670 SW EAGLE DR
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-3650
Practice Address - Country:US
Practice Address - Phone:352-872-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE AFROWHISPERER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-02
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty