Provider Demographics
NPI:1548499486
Name:WHOLISTIC HOME CARE OF MAINE
Entity type:Organization
Organization Name:WHOLISTIC HOME CARE OF MAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:RACKLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:207-441-2768
Mailing Address - Street 1:140 HUNTS MEADOW ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04353
Mailing Address - Country:US
Mailing Address - Phone:207-441-2768
Mailing Address - Fax:
Practice Address - Street 1:37 BRUNSWICK AVE.
Practice Address - Street 2:SUITE 1
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345
Practice Address - Country:US
Practice Address - Phone:207-441-2768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
ME06142013253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health