Provider Demographics
NPI:1558014415
Name:RENOVATE YOUR PLATE
Entity Type:Organization
Organization Name:RENOVATE YOUR PLATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEKER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:317-508-3427
Mailing Address - Street 1:1030 CENTRAL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2794
Mailing Address - Country:US
Mailing Address - Phone:317-508-3427
Mailing Address - Fax:
Practice Address - Street 1:1030 CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2794
Practice Address - Country:US
Practice Address - Phone:317-508-3427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports DieteticsGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty