Provider Demographics
NPI:1558697326
Name:FOOD STUFF, INC.
Entity Type:Organization
Organization Name:FOOD STUFF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,CDE
Authorized Official - Phone:309-830-0711
Mailing Address - Street 1:10338 N 1750 EAST RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-5950
Mailing Address - Country:US
Mailing Address - Phone:309-830-0711
Mailing Address - Fax:866-592-3004
Practice Address - Street 1:10338 N 1750 EAST RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-5950
Practice Address - Country:US
Practice Address - Phone:309-830-0711
Practice Address - Fax:866-592-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001279133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty