| Community Holistic Practice Llc | |
|
6515 E Livingston Ave Ste B6a Reynoldsburg OH 43068-3562 | |
| (614) 218-2105 | |
| Not Available |
| Full Name | Community Holistic Practice Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 6515 E Livingston Ave Ste B6a, Reynoldsburg, Ohio |
| Authorized Official Name and Position | Faustina Dindiok (CEO) |
| Authorized Official Contact | 6142182105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Holistic Practice Llc 6515 E Livingston Ave Ste B6a Reynoldsburg OH 43068-3562 Ph: (614) 218-2105 | Community Holistic Practice Llc 6515 E Livingston Ave Ste B6a Reynoldsburg OH 43068-3562 Ph: (614) 218-2105 |
| NPI Number | 1386420560 |
|---|---|
| Provider Enumeration Date | 09/05/2023 |
| Last Update Date | 01/26/2024 |
| Certification Date | 01/26/2024 |
| Medicare PECOS PAC ID | 4880130970 |
|---|---|
| Medicare Enrollment ID | O20240725000935 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386420560 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Faustina Datamit Dindiok |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295298792 PECOS PAC ID: 6800207275 Enrollment ID: I20240404002463 |
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