Provider Demographics
NPI:1063826444
Name:FOOD COACH, LLC
Entity Type:Organization
Organization Name:FOOD COACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LD
Authorized Official - Phone:603-387-2622
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-1342
Mailing Address - Country:US
Mailing Address - Phone:603-387-2622
Mailing Address - Fax:888-974-6009
Practice Address - Street 1:501 UNION AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-387-2622
Practice Address - Fax:888-974-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty