Healthcare Provider Details

I. General information

NPI: 1679194369
Provider Name (Legal Business Name): THRIVE MILE HEALTH CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E FRANKLIN ST
BALTIMORE MD
21202-2203
US

IV. Provider business mailing address

17 E FRANKLIN ST
BALTIMORE MD
21202-2203
US

V. Phone/Fax

Practice location:
  • Phone: 410-600-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BETTY GITHUKU
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 443-798-8245