Provider Demographics
NPI:1063819472
Name:FOOD MATTERS 365, LLC
Entity Type:Organization
Organization Name:FOOD MATTERS 365, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BOSTICK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CSO , LDN
Authorized Official - Phone:336-291-3622
Mailing Address - Street 1:301 S ELM ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2696
Mailing Address - Country:US
Mailing Address - Phone:336-291-3622
Mailing Address - Fax:336-814-2116
Practice Address - Street 1:301 S ELM ST
Practice Address - Street 2:SUITE 801
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2696
Practice Address - Country:US
Practice Address - Phone:336-291-3622
Practice Address - Fax:336-814-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003817133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty