Provider Demographics
NPI:1154488443
Name:NUTRITION WELLNESS SOLUTIONS, INC.
Entity Type:Organization
Organization Name:NUTRITION WELLNESS SOLUTIONS, INC.
Other - Org Name:KY CENTER FOR EATING & WEIGHT DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD
Authorized Official - Phone:859-219-8953
Mailing Address - Street 1:851 CORPORATE DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5428
Mailing Address - Country:US
Mailing Address - Phone:859-219-8953
Mailing Address - Fax:859-543-0928
Practice Address - Street 1:851 CORPORATE DR
Practice Address - Street 2:SUITE 330
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5428
Practice Address - Country:US
Practice Address - Phone:859-219-8953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUTRITION WELLNESS SOLUTIONS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7075Medicare ID - Type UnspecifiedGROUP