Provider Demographics
NPI:1265055461
Name:WHOLENESS HEALTH, LLC
Entity type:Organization
Organization Name:WHOLENESS HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-224-9458
Mailing Address - Street 1:2620 E PROSPECT RD STE 190
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9098
Mailing Address - Country:US
Mailing Address - Phone:970-221-1106
Mailing Address - Fax:970-232-1050
Practice Address - Street 1:2620 E PROSPECT RD STE 190
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9098
Practice Address - Country:US
Practice Address - Phone:970-221-1106
Practice Address - Fax:970-232-1050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHOLENESS HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch