Provider Demographics
NPI:1083245575
Name:HAPPY HEALTH AND NUTRITION, LLC
Entity Type:Organization
Organization Name:HAPPY HEALTH AND NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN LDN
Authorized Official - Phone:312-882-1162
Mailing Address - Street 1:10240 S 80TH CT
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1405
Mailing Address - Country:US
Mailing Address - Phone:312-882-1162
Mailing Address - Fax:708-690-3108
Practice Address - Street 1:10240 S 80TH CT
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1405
Practice Address - Country:US
Practice Address - Phone:312-882-1162
Practice Address - Fax:708-690-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619308608Medicaid