Provider Demographics
NPI:1356984231
Name:THRIVAL NUTRITION, LLC
Entity type:Organization
Organization Name:THRIVAL NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:CCN
Authorized Official - Phone:321-213-1177
Mailing Address - Street 1:108 WILD BASIN RD STE 250
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3468
Mailing Address - Country:US
Mailing Address - Phone:512-501-2611
Mailing Address - Fax:
Practice Address - Street 1:108 WILD BASIN RD STE 250
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-3468
Practice Address - Country:US
Practice Address - Phone:512-501-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty