Provider Demographics
NPI:1174288062
Name:ALYSSA REIDHEAD ENTERPRISES LLC
Entity type:Organization
Organization Name:ALYSSA REIDHEAD ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:SHAELYN
Authorized Official - Last Name:REIDHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:702-423-7657
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-0108
Mailing Address - Country:US
Mailing Address - Phone:702-423-7657
Mailing Address - Fax:
Practice Address - Street 1:128 S 1350 E
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-2029
Practice Address - Country:US
Practice Address - Phone:702-423-7657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty