Provider Demographics
NPI:1093094625
Name:NUTRITIONALLY SOUND, LLC
Entity Type:Organization
Organization Name:NUTRITIONALLY SOUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RD
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEG
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:RD-LDN
Authorized Official - Phone:401-245-8784
Mailing Address - Street 1:38 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-1906
Mailing Address - Country:US
Mailing Address - Phone:401-245-8784
Mailing Address - Fax:401-245-2009
Practice Address - Street 1:2444 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4025
Practice Address - Country:US
Practice Address - Phone:401-245-8784
Practice Address - Fax:401-245-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-13
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2100261QH0100X
RILDN00587261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service