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General NPI Number Information
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NPI Number | 1356182901
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Entity Type | Organization
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Legal Business Name | NIMBA HOLDINGS, LLC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 4955 SUMMIT ARBOR DR
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City | RALEIGH
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State | NC
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Zip | 27612-3337
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Country | US
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Telephone | 424-394-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 3343 BRACHENBURY LN
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | SAYE ZENGBEAN
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Credential |
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Telephone | 424-394-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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