Provider Demographics
NPI:1275862807
Name:THRIVE FAMILY NUTRITION SERVICES, LLC
Entity Type:Organization
Organization Name:THRIVE FAMILY NUTRITION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CD
Authorized Official - Phone:801-857-7440
Mailing Address - Street 1:374 S 1230 W
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5531
Mailing Address - Country:US
Mailing Address - Phone:801-857-7440
Mailing Address - Fax:866-340-7791
Practice Address - Street 1:910 E 100 N
Practice Address - Street 2:SUITE 105
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1635
Practice Address - Country:US
Practice Address - Phone:801-857-7440
Practice Address - Fax:866-340-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6324049-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty