Provider Demographics
NPI:1497171250
Name:ULTIMATE NUTRITION SOLUTION LLC
Entity Type:Organization
Organization Name:ULTIMATE NUTRITION SOLUTION LLC
Other - Org Name:360 NUTRITION SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:561-445-0395
Mailing Address - Street 1:5238 PALM RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1157
Mailing Address - Country:US
Mailing Address - Phone:561-445-0395
Mailing Address - Fax:
Practice Address - Street 1:5238 PALM RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1157
Practice Address - Country:US
Practice Address - Phone:561-445-0395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6231133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty