Provider Demographics
NPI:1275218356
Name:EMERALD FARE NUTRITION SERVICES, LLC.
Entity Type:Organization
Organization Name:EMERALD FARE NUTRITION SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:CANTERBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDECS
Authorized Official - Phone:304-395-5530
Mailing Address - Street 1:816 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-2519
Mailing Address - Country:US
Mailing Address - Phone:304-395-5530
Mailing Address - Fax:681-245-6369
Practice Address - Street 1:816 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-2519
Practice Address - Country:US
Practice Address - Phone:304-395-5530
Practice Address - Fax:681-245-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty