Provider Demographics
NPI:1629960414
Name:GREAT HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:GREAT HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAPETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-221-3553
Mailing Address - Street 1:23192 L ERMITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7153
Mailing Address - Country:US
Mailing Address - Phone:561-221-3553
Mailing Address - Fax:
Practice Address - Street 1:23192 L ERMITAGE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7153
Practice Address - Country:US
Practice Address - Phone:561-221-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service