Provider Demographics
NPI:1184179608
Name:ART OF LIVING HEALTHY, LLC
Entity Type:Organization
Organization Name:ART OF LIVING HEALTHY, LLC
Other - Org Name:MONARCH HEALTH & FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALONICK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:352-228-3050
Mailing Address - Street 1:19046 LAKE SWATARA DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-7709
Mailing Address - Country:US
Mailing Address - Phone:352-228-3050
Mailing Address - Fax:
Practice Address - Street 1:2719 W OLD US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3526
Practice Address - Country:US
Practice Address - Phone:352-729-6877
Practice Address - Fax:352-729-6877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGH879AMedicare PIN