Provider Demographics
NPI:1538298385
Name:SPECIALTY NUTRITION AND HEALTH
Entity Type:Organization
Organization Name:SPECIALTY NUTRITION AND HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHITT
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:804-864-1998
Mailing Address - Street 1:10640 CHARTER HILL CT
Mailing Address - Street 2:SUITE103
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7749
Mailing Address - Country:US
Mailing Address - Phone:804-864-1998
Mailing Address - Fax:804-864-1997
Practice Address - Street 1:10640 CHARTER HILL CT
Practice Address - Street 2:SUITE103
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7749
Practice Address - Country:US
Practice Address - Phone:804-864-1998
Practice Address - Fax:804-864-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
832794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
190000697Medicare UPIN