Provider Demographics
NPI:1497485254
Name:SNAPP BACK TO HEALTH LLC
Entity Type:Organization
Organization Name:SNAPP BACK TO HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:248-252-9730
Mailing Address - Street 1:20905 GREENFIELD RD STE 303
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5347
Mailing Address - Country:US
Mailing Address - Phone:248-450-3177
Mailing Address - Fax:
Practice Address - Street 1:20905 GREENFIELD RD STE 303
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5347
Practice Address - Country:US
Practice Address - Phone:248-450-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty