Provider Demographics
NPI:1255680286
Name:SUPERIOR SUSTENANCE, LLC
Entity Type:Organization
Organization Name:SUPERIOR SUSTENANCE, LLC
Other - Org Name:SUPERIOR SUSTENANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:480-577-7046
Mailing Address - Street 1:1745 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3009
Mailing Address - Country:US
Mailing Address - Phone:480-577-7046
Mailing Address - Fax:
Practice Address - Street 1:1745 S ALMA SCHOOL RD
Practice Address - Street 2:STE 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3009
Practice Address - Country:US
Practice Address - Phone:480-577-7046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ990773133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty