Provider Demographics
NPI:1356825145
Name:GOOD HEALTH NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:GOOD HEALTH NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:OMERENNAH
Authorized Official - Suffix:
Authorized Official - Credentials:RDLD/N
Authorized Official - Phone:240-475-2966
Mailing Address - Street 1:210 SETTLERS WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5770
Mailing Address - Country:US
Mailing Address - Phone:301-341-4680
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 129-37
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-341-4680
Practice Address - Fax:301-341-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty