Provider Demographics
NPI:1003691353
Name:FIT FAMILY NUTRITION LLC
Entity Type:Organization
Organization Name:FIT FAMILY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALAMARCHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDCES
Authorized Official - Phone:757-618-7474
Mailing Address - Street 1:22 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-1042
Mailing Address - Country:US
Mailing Address - Phone:757-618-7474
Mailing Address - Fax:888-972-7994
Practice Address - Street 1:3235 ACADEMY AVE STE 301
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3200
Practice Address - Country:US
Practice Address - Phone:757-484-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service