Provider Demographics
NPI:1508052085
Name:HEALTH & NUTRITION SERVICE OF RACINE, INC.
Entity Type:Organization
Organization Name:HEALTH & NUTRITION SERVICE OF RACINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:262-637-7750
Mailing Address - Street 1:2316 RAPIDS DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-2011
Mailing Address - Country:US
Mailing Address - Phone:262-637-7750
Mailing Address - Fax:262-637-7926
Practice Address - Street 1:2316 RAPIDS DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-2011
Practice Address - Country:US
Practice Address - Phone:262-637-7750
Practice Address - Fax:262-637-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44010800Medicaid
WI41858300Medicaid