Provider Demographics
NPI:1861128985
Name:WHOLE HEALTH SERVICES
Entity type:Organization
Organization Name:WHOLE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SURASKY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:510-342-2380
Mailing Address - Street 1:2206 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1714
Mailing Address - Country:US
Mailing Address - Phone:510-342-2380
Mailing Address - Fax:844-649-0670
Practice Address - Street 1:1700 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-3402
Practice Address - Country:US
Practice Address - Phone:510-845-8017
Practice Address - Fax:844-649-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA863934OtherOPTUM PROVIDER ID
CA12493637OtherCAQH PROVIDER ID