Provider Demographics
NPI:1396022778
Name:DIETARY SOLUTIONS OF INDIANA, PC
Entity Type:Organization
Organization Name:DIETARY SOLUTIONS OF INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:317-847-4225
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-0456
Mailing Address - Country:US
Mailing Address - Phone:317-847-4225
Mailing Address - Fax:
Practice Address - Street 1:11979 SLOANE MUSE
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4158
Practice Address - Country:US
Practice Address - Phone:317-847-4225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000119A252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency