Provider Demographics
NPI:1659849909
Name:SANATIVE LLC
Entity type:Organization
Organization Name:SANATIVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:HUC
Authorized Official - Phone:828-595-9331
Mailing Address - Street 1:30 MOUNTAIN TER
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1924
Mailing Address - Country:US
Mailing Address - Phone:828-595-9331
Mailing Address - Fax:800-515-1908
Practice Address - Street 1:9900 N CENTRAL EXPY STE 555
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0984
Practice Address - Country:US
Practice Address - Phone:714-267-0226
Practice Address - Fax:214-935-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty