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General NPI Number Information
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NPI Number | 1043819006
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Entity Type | Organization
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Legal Business Name | BATTLE BORN WELLNESS, LLC
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 3732 LAKESIDE DR STE 202
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City | RENO
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State | NV
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Zip | 89509-5278
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Country | US
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Telephone | 775-399-9327
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Fax |
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Provider Business Mailing Address
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Address Line | 100 VERONICA AVE
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City | SPARKS
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State | NV
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Zip | 89436-8908
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Country | US
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Telephone | 775-399-9327
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | KRISTIN MOORE
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Credential |
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Telephone | 775-399-9327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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