Organization
REVIVERE NUTRITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLINE GROSCH RD, LD, CNSC (REGISTERED DIETITIAN)
(978) 304-2794
Entity
Organization
Contact information
Practice address
514 SILVER MAPLE LN, WOODSTOCK, GA 30189-6907
(978) 304-2794
Mailing address
514 SILVER MAPLE LN, WOODSTOCK, GA 30189-6907
(978) 304-2794
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770368060
—
GA
Enumeration date
03/05/2025
Last updated
03/05/2025
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