Provider Demographics
NPI:1346401510
Name:THE BEACHED WHALE SWIMS PL
Entity Type:Organization
Organization Name:THE BEACHED WHALE SWIMS PL
Other - Org Name:FREEWILL NUTRITION & DIABETES SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:RD LDN CDE
Authorized Official - Phone:386-546-5732
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:INTERLACHEN
Mailing Address - State:FL
Mailing Address - Zip Code:32148-1657
Mailing Address - Country:US
Mailing Address - Phone:386-546-5732
Mailing Address - Fax:888-391-3648
Practice Address - Street 1:6050 SAINT JOHNS AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6860
Practice Address - Country:US
Practice Address - Phone:386-546-5732
Practice Address - Fax:888-391-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2522133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty