Provider Demographics
NPI:1396259420
Name:WHOLE LIFE SERVICES LLC
Entity type:Organization
Organization Name:WHOLE LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:EHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:ICS, CSAC
Authorized Official - Phone:715-645-0336
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-0093
Mailing Address - Country:US
Mailing Address - Phone:715-645-0336
Mailing Address - Fax:715-645-0336
Practice Address - Street 1:819 ASH ST STE 150
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1201
Practice Address - Country:US
Practice Address - Phone:715-645-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11506-135324500000X
WI1819-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty