Provider Demographics
NPI:1699437509
Name:WHOLESOME, LLC
Entity type:Organization
Organization Name:WHOLESOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-242-4592
Mailing Address - Street 1:2236 W. BETHANY HOME
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1934
Mailing Address - Country:US
Mailing Address - Phone:602-242-4592
Mailing Address - Fax:602-242-9220
Practice Address - Street 1:2236 W. BETHANY HOME
Practice Address - Street 2:SUITE #2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1934
Practice Address - Country:US
Practice Address - Phone:602-242-4592
Practice Address - Fax:602-242-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty