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General NPI Number Information
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NPI Number | 1245967124
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Entity Type | Organization
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Legal Business Name | 360 FIT LIFE, INC.
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 1487 N HIGH ST STE 1A
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City | HILLSBORO
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State | OH
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Zip | 45133-8496
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Country | US
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Telephone | 859-391-1957
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Fax |
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Provider Business Mailing Address
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Address Line | 105 RIDGEPOINTE DR
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City | COLD SPRING
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State | KY
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Zip | 41076-9091
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Country | US
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Telephone | 859-391-1957
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DEEPAK MITTAL
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Credential |
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Telephone | 859-391-1957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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