Provider Demographics
NPI:1427261551
Name:WHOLISTIC INC.
Entity type:Organization
Organization Name:WHOLISTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-947-8117
Mailing Address - Street 1:4752 S ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1818
Mailing Address - Country:US
Mailing Address - Phone:773-624-7803
Mailing Address - Fax:
Practice Address - Street 1:1734 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1913
Practice Address - Country:US
Practice Address - Phone:773-947-8117
Practice Address - Fax:773-947-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty