Provider Demographics
NPI:1164699625
Name:MASSHOME SOLUTIONS, INC
Entity Type:Organization
Organization Name:MASSHOME SOLUTIONS, INC
Other - Org Name:MEDICAL NUTRITION THERAPY WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOURDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:617-461-8503
Mailing Address - Street 1:9 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1914
Mailing Address - Country:US
Mailing Address - Phone:617-461-8503
Mailing Address - Fax:617-249-1769
Practice Address - Street 1:3 LOPEZ RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2563
Practice Address - Country:US
Practice Address - Phone:617-461-8503
Practice Address - Fax:617-249-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2490133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty