Provider Demographics
NPI:1104395953
Name:THRIVE NUTRITION, LLC
Entity Type:Organization
Organization Name:THRIVE NUTRITION, LLC
Other - Org Name:THRIVE NUTRITION LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ASTRIDA
Authorized Official - Middle Name:AWA
Authorized Official - Last Name:TENENG
Authorized Official - Suffix:
Authorized Official - Credentials:CDCES, RD
Authorized Official - Phone:502-303-7705
Mailing Address - Street 1:16567 SIOUX LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2048
Mailing Address - Country:US
Mailing Address - Phone:502-303-7705
Mailing Address - Fax:
Practice Address - Street 1:9711 WASHINGTONIAN BLVD STE 550
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5789
Practice Address - Country:US
Practice Address - Phone:502-303-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12585463OtherCAQH