Provider Demographics
NPI:1023620481
Name:HOLY HOLLISTIC REHABILITATION SERVICES
Entity type:Organization
Organization Name:HOLY HOLLISTIC REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTION PROFESSIONAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-865-0074
Mailing Address - Street 1:11300 N W 40 STREET CORAL SPRINGS FL 33065
Mailing Address - Street 2:4846 N UNIVERSITY DR SUITE 241
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:754-249-8263
Mailing Address - Fax:
Practice Address - Street 1:11300 NW 40TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-7738
Practice Address - Country:US
Practice Address - Phone:754-249-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health