Provider Demographics
NPI:1437716396
Name:HOMETOWN NOURISHED L.L.C.
Entity Type:Organization
Organization Name:HOMETOWN NOURISHED L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DI FABIO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:732-713-3970
Mailing Address - Street 1:61 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1810
Mailing Address - Country:US
Mailing Address - Phone:732-713-3970
Mailing Address - Fax:
Practice Address - Street 1:485C US HIGHWAY 1 SOUTH
Practice Address - Street 2:SUITE 350, ROOM 104
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-0883
Practice Address - Country:US
Practice Address - Phone:732-713-3970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty