Provider Demographics
NPI:1154496305
Name:MINTER NUTRITION SERVICES, INC.
Entity Type:Organization
Organization Name:MINTER NUTRITION SERVICES, INC.
Other - Org Name:EARTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MINTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CD
Authorized Official - Phone:574-202-0704
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:20111 REGINA ROAD
Mailing Address - City:NEW PARIS
Mailing Address - State:IN
Mailing Address - Zip Code:46553-0629
Mailing Address - Country:US
Mailing Address - Phone:574-202-0704
Mailing Address - Fax:574-831-6795
Practice Address - Street 1:20111 REGINA RD
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:IN
Practice Address - Zip Code:46553-9632
Practice Address - Country:US
Practice Address - Phone:574-202-0704
Practice Address - Fax:574-831-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000537A133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty