| NPI | 1366051823 |
|---|---|
| Other Name | MY HOLISTIC LIFE, LLC |
| Entity Type | Organization |
| Authorized Contact | RONDA MAE WELTY Owner 901-568-0442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |