Healthcare Provider Details

I. General information

NPI: 1356182901
Provider Name (Legal Business Name): NIMBA HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 SUMMIT ARBOR DR
RALEIGH NC
27612-3337
US

IV. Provider business mailing address

3343 BRACHENBURY LN
JACKSONVILLE FL
32225-3709
US

V. Phone/Fax

Practice location:
  • Phone: 424-394-5554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAYE ZENGBEAN
Title or Position: COO
Credential:
Phone: 424-394-5554