Provider Demographics
NPI:1558085902
Name:CHAMPLAIN NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:CHAMPLAIN NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:802-989-1942
Mailing Address - Street 1:64 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-0000
Mailing Address - Country:US
Mailing Address - Phone:802-989-1942
Mailing Address - Fax:802-419-3715
Practice Address - Street 1:64 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-0000
Practice Address - Country:US
Practice Address - Phone:802-989-1942
Practice Address - Fax:802-419-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty