Provider Demographics
NPI:1073186607
Name:ALYSSA REIDHEAD ENTERPRISES LLC
Entity Type:Organization
Organization Name:ALYSSA REIDHEAD ENTERPRISES LLC
Other - Org Name:RURAL DIETITIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:REIDHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:702-423-7657
Mailing Address - Street 1:128 S 1350 E
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-2029
Mailing Address - Country:US
Mailing Address - Phone:435-200-9319
Mailing Address - Fax:435-200-9319
Practice Address - Street 1:128 S 1350 E
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-2029
Practice Address - Country:US
Practice Address - Phone:702-423-7657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty