Provider Demographics
NPI:1467842328
Name:HEALTHY NUTRITION SERVICE
Entity Type:Organization
Organization Name:HEALTHY NUTRITION SERVICE
Other - Org Name:HEALTHY NUTRITION SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:817-995-4677
Mailing Address - Street 1:110 PONY EXPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3132
Mailing Address - Country:US
Mailing Address - Phone:817-995-4677
Mailing Address - Fax:817-549-0207
Practice Address - Street 1:110 PONY EXPRESS TRL
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3132
Practice Address - Country:US
Practice Address - Phone:817-995-4677
Practice Address - Fax:817-549-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80298261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service