Healthcare Provider Details

I. General information

NPI: 1285469023
Provider Name (Legal Business Name): NUTURE OF THRIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ARBOR CREEK OVERLOOK
ROSWELL GA
30076-5813
US

IV. Provider business mailing address

400 ARBOR CREEK OVERLOOK
ROSWELL GA
30076-5813
US

V. Phone/Fax

Practice location:
  • Phone: 404-667-4777
  • Fax:
Mailing address:
  • Phone: 404-667-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAN DAO
Title or Position: OWNER
Credential:
Phone: 404-667-4777