Provider Demographics
NPI:1033377429
Name:HOPE NUTRITIONAL SERVICES
Entity Type:Organization
Organization Name:HOPE NUTRITIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD
Authorized Official - Prefix:
Authorized Official - First Name:SCHELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LD
Authorized Official - Phone:9122-262-9966
Mailing Address - Street 1:154 CORNERSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525
Mailing Address - Country:US
Mailing Address - Phone:912-262-9966
Mailing Address - Fax:912-262-9976
Practice Address - Street 1:154 CORNERSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-3152
Practice Address - Country:US
Practice Address - Phone:912-262-9966
Practice Address - Fax:912-262-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480919984AMedicaid