Provider Demographics
NPI:1578195590
Name:SALATINO NUTRITION, LLC
Entity Type:Organization
Organization Name:SALATINO NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RABUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:804-359-1155
Mailing Address - Street 1:9331 CRESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2923
Mailing Address - Country:US
Mailing Address - Phone:804-359-1155
Mailing Address - Fax:
Practice Address - Street 1:9331 CRESTFIELD DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2923
Practice Address - Country:US
Practice Address - Phone:804-359-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency