Provider Demographics
NPI:1053464453
Name:HEALTHFUL LIVING LLC
Entity Type:Organization
Organization Name:HEALTHFUL LIVING LLC
Other - Org Name:PEAK NUTRITION WORKS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:720-837-5240
Mailing Address - Street 1:303 GLENVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-1314
Mailing Address - Country:US
Mailing Address - Phone:720-837-5240
Mailing Address - Fax:303-772-8207
Practice Address - Street 1:1309 SUNSET ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3215
Practice Address - Country:US
Practice Address - Phone:720-684-4147
Practice Address - Fax:303-651-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO949745133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty