=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801619614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTERING AFFINITY TO THRIVE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 PARTRIDGE DR
-----------------------------------------------------
City | ESSEX JCT
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05452-3979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-951-0450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 PARTRIDGE DR
-----------------------------------------------------
City | ESSEX JCT
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05452-3979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-951-0450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LINDA LI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-951-0450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------