Provider Demographics
NPI:1376926600
Name:A REVOLUTION IN NUTRITION
Entity Type:Organization
Organization Name:A REVOLUTION IN NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELRAE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-953-2940
Mailing Address - Street 1:8578 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6726
Mailing Address - Country:US
Mailing Address - Phone:330-953-2940
Mailing Address - Fax:330-953-2943
Practice Address - Street 1:8578 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6726
Practice Address - Country:US
Practice Address - Phone:330-953-2940
Practice Address - Fax:330-953-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals