Provider Demographics
NPI:1295577062
Name:LET'S RETREAT LLC
Entity type:Organization
Organization Name:LET'S RETREAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:NUZUM
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:404-277-1474
Mailing Address - Street 1:2048 SANDERLINGS DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5816
Mailing Address - Country:US
Mailing Address - Phone:404-277-1474
Mailing Address - Fax:
Practice Address - Street 1:2048 SANDERLINGS DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-5816
Practice Address - Country:US
Practice Address - Phone:404-277-1474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health