Provider Demographics
NPI:1154628485
Name:EAT AND RUN, LLC
Entity Type:Organization
Organization Name:EAT AND RUN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:413-461-8844
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-0095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:263 W PELHAM RD
Practice Address - Street 2:
Practice Address - City:SHUTESBURY
Practice Address - State:MA
Practice Address - Zip Code:01072-9704
Practice Address - Country:US
Practice Address - Phone:413-461-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000003056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty