Provider Demographics
NPI:1275177560
Name:TRAVELING MAMA ENTERPRISES, LLC
Entity Type:Organization
Organization Name:TRAVELING MAMA ENTERPRISES, LLC
Other - Org Name:HOME GROWN NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CLC, RDN
Authorized Official - Phone:406-209-3995
Mailing Address - Street 1:6110 SPRINGHILL RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8722
Mailing Address - Country:US
Mailing Address - Phone:406-209-3995
Mailing Address - Fax:
Practice Address - Street 1:6110 SPRINGHILL RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8722
Practice Address - Country:US
Practice Address - Phone:406-209-3995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMED-NUTR-LIC-408OtherSTATE LICENSE