Provider Demographics
NPI:1558657510
Name:IN HOME NUTRITON
Entity Type:Organization
Organization Name:IN HOME NUTRITON
Other - Org Name:CATALYST FOR CHANGE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCCLOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:734-756-7036
Mailing Address - Street 1:149 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1245
Mailing Address - Country:US
Mailing Address - Phone:734-756-7036
Mailing Address - Fax:
Practice Address - Street 1:149 PINE CREEK DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1245
Practice Address - Country:US
Practice Address - Phone:734-756-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA832566133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty