Provider Demographics
NPI:1568267037
Name:HOLISTIC SPACE LLC
Entity type:Organization
Organization Name:HOLISTIC SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:689-261-1777
Mailing Address - Street 1:964 HIGH HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3574
Mailing Address - Country:US
Mailing Address - Phone:689-261-1777
Mailing Address - Fax:
Practice Address - Street 1:5540 MCNEELY DR STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:689-261-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center