Provider Demographics
NPI:1083232474
Name:CLINICIAN'S INCUBATOR LLC
Entity Type:Organization
Organization Name:CLINICIAN'S INCUBATOR LLC
Other - Org Name:NUTRITION HIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:LDN, CNS, MS, MA
Authorized Official - Phone:302-893-3801
Mailing Address - Street 1:811 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2805
Mailing Address - Country:US
Mailing Address - Phone:302-893-3801
Mailing Address - Fax:
Practice Address - Street 1:5250 OLD ORCHARD RD STE 300
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4462
Practice Address - Country:US
Practice Address - Phone:888-536-2836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-11
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty