Provider Demographics
NPI:1114709573
Name:BALANCED BITES NUTRITION LLC
Entity Type:Organization
Organization Name:BALANCED BITES NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTO
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDCES, CSOWM
Authorized Official - Phone:208-954-0862
Mailing Address - Street 1:803 S SHORT LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4122
Mailing Address - Country:US
Mailing Address - Phone:208-954-0862
Mailing Address - Fax:208-668-8871
Practice Address - Street 1:803 S SHORT LN
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4122
Practice Address - Country:US
Practice Address - Phone:208-954-0862
Practice Address - Fax:208-668-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty