Healthcare Provider Details

I. General information

NPI: 1437972858
Provider Name (Legal Business Name): NU LIFE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 OXBOW DR
CEDAR HILL TX
75104-4006
US

IV. Provider business mailing address

1434 OXBOW DR
CEDAR HILL TX
75104-4006
US

V. Phone/Fax

Practice location:
  • Phone: 214-477-5594
  • Fax:
Mailing address:
  • Phone: 214-477-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLORIA TABRON
Title or Position: OWNER
Credential:
Phone: 214-477-5594