MY HOLISTIC LIFE, LLC (NPI# 1366051823) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366051823 |
| Entity Type | Organization |
| Organization Name | MY HOLISTIC LIFE, LLC |
| Practice Address |
10454 Juneau Way Collierville TN 38017-1968 |
| Practice Telephone | 9015680442 |
| Practice Fax Number | 9012840008 |
| Mailing Telephone | 9015680442 |
| Mailing Fax Number | 9012840008 |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |
| Authorized Official Name | RONDA MAE WELTY (OWNER) |
| Authorized Official Telephone | 9015680442 |
| Authorized Official Credential | COTA/L, CAPS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities | ||
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | OTA LICENSE | 1286 | 01 |
| Other Name | Type Code |
|---|---|
| My Holistic Life, LLC | Other Name - Individual/Organization |
| Street Address |
10454 JUNEAU WAY |
| City | COLLIERVILLE |
| State | TN |
| Zip Code | 38017-1968 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827338 | George Nathan Freeman IIi | Chiropractor | 2028 W. Poplar, Suite 105, Collierville, TN 38017 | 2020-10-01 |
| 1104440171 | Cecelia Hunt | Social Worker | 2555 Halle Parkwsy, Collierville, TN 38017 | 2020-06-04 |
| 1053803403 | Sarah Harris | Physical Therapist | 605 Heather Lake Cv, Collierville, TN 38017 | 2018-06-01 |
| 1023507811 | Sandra P Morris | Pharmacist | 560 West Poplar, Collierville, TN 38017 | 2018-05-07 |
| 1043751159 | Rahim Panjwani | Physical Therapist | 2028 W. Poplar Ave, Collierville, TN 38017 | 2017-03-09 |
| 1104273234 | The Branch House | Counselor | 562 Center St, Collierville, TN 38017 | 2016-05-18 |
| 1760840052 | Amodeo Chiropractic Center Inc | Chiropractor | 161 Hwy 72 East, Collierville, TN 38017 | 2016-02-02 |
| 1235520628 | Bonnie Morales | Nurse Practitioner | 472 W. Poplar Ave, Collierville, TN 38017 | 2015-02-06 |
| 1841616513 | First Choice Transportation | Non-emergency Medical Transport (VAN) | 336 E. Valleywood Drive, Collierville, TN 38017 | 2014-03-05 |
| 1821424276 | Shana Cole Cannon | Licensed Practical Nurse | 777 W. Poplar Ave., Suite 104, Collierville, TN 38017 | 2013-09-17 |
| Find all providers in zip 38017 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194332148 | Talley Boarding Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2741 Smith Springs Rd, Nashville, TN 37217 | 2020-09-24 |
| 1821613571 | Jasmine E Jackson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3165 Overton Crossing St, Memphis, TN 38127-6522 | 2020-06-09 |
| 1780208116 | Indya Daniels | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 262 Carriage House Dr, Jackson, TN 38305-2228 | 2020-06-01 |
| 1841830387 | Charis | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8820 Trinity Rd Ste 101, Cordova, TN 38018-2735 | 2020-01-13 |
| 1447891171 | Hamelmal S Admassie | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 880 Pin Oak Dr, Antioch, TN 37013-1532 | 2019-10-03 |
| 1285294306 | Kiarad Enterprises Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3994 Edenburg Dr, Memphis, TN 38127-4112 | 2019-06-20 |
| 1467910992 | Milestone Home Healthcare Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1037 Jefferson St Ste G, Nashville, TN 37208-2554 | 2019-03-04 |
| 1255897831 | Salim Homes Residential Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2714 Deerfield Dr, Nashville, TN 37208-1225 | 2019-02-19 |
| 1407324411 | Abundant Care Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2805 Foster Ave Ste 206, Nashville, TN 37210-5341 | 2018-11-07 |
| 1558837104 | Vicki Mckissick | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2131 Murfreesboro Pike Ste 210, Nashville, TN 37217-6306 | 2018-10-22 |
| Find all providers with the same taxonomy | ||||
| City | COLLIERVILLE |
| Zip Code | 38017 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.