Provider Demographics
NPI:1326748070
Name:SERAPHIM NUTRITION LC
Entity Type:Organization
Organization Name:SERAPHIM NUTRITION LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:269-290-3248
Mailing Address - Street 1:1865 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3019
Mailing Address - Country:US
Mailing Address - Phone:269-290-3248
Mailing Address - Fax:
Practice Address - Street 1:1865 PARTRIDGE LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3019
Practice Address - Country:US
Practice Address - Phone:269-290-3248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local