Provider Demographics
NPI:1376812917
Name:BEST NUTRITION SERVICES OF INDIANA, LLC
Entity Type:Organization
Organization Name:BEST NUTRITION SERVICES OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:317-509-4018
Mailing Address - Street 1:9608 N CRAWFORD STREET
Mailing Address - Street 2:
Mailing Address - City:KNIGHTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47857
Mailing Address - Country:US
Mailing Address - Phone:317-509-4018
Mailing Address - Fax:
Practice Address - Street 1:9608 NORTH CRAWFORD STREET
Practice Address - Street 2:
Practice Address - City:KNIGHTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47857
Practice Address - Country:US
Practice Address - Phone:317-509-4018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000533A252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency