Provider Demographics
NPI:1003382227
Name:TRANSFORMING NUTRITION CARE
Entity Type:Organization
Organization Name:TRANSFORMING NUTRITION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:REDDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD LN
Authorized Official - Phone:406-579-9182
Mailing Address - Street 1:14 SOUTH WILLSON AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-579-9182
Mailing Address - Fax:406-551-1208
Practice Address - Street 1:14 SOUTH WILLSON AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-579-9182
Practice Address - Fax:406-551-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM01100Medicaid