Provider Demographics
NPI:1568094092
Name:GRATEFUL MEAL NUTRITION, LLC
Entity Type:Organization
Organization Name:GRATEFUL MEAL NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:843-882-5085
Mailing Address - Street 1:5033 WAPITI WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-6284
Mailing Address - Country:US
Mailing Address - Phone:843-882-5085
Mailing Address - Fax:
Practice Address - Street 1:5033 WAPITI WAY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-6284
Practice Address - Country:US
Practice Address - Phone:843-882-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty