Provider Demographics
NPI:1962929125
Name:TOMS HOLISTIC HOME VISITS PLLC
Entity type:Organization
Organization Name:TOMS HOLISTIC HOME VISITS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:S
Authorized Official - Last Name:DRAGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:734-451-0600
Mailing Address - Street 1:28675 FRANKLIN RD APT 217
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28675 FRANKLIN RD
Practice Address - Street 2:SUITE 217
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:734-451-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704277552261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid