Provider Demographics
NPI:1609128784
Name:HEALTHY HEARTS NUTRITION LLC
Entity Type:Organization
Organization Name:HEALTHY HEARTS NUTRITION LLC
Other - Org Name:CLEM&THYME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:CLEM
Authorized Official - Last Name:EDMUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, LD
Authorized Official - Phone:937-206-1131
Mailing Address - Street 1:4549 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9747
Mailing Address - Country:US
Mailing Address - Phone:937-206-1131
Mailing Address - Fax:
Practice Address - Street 1:4359 E ENON RD
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-9708
Practice Address - Country:US
Practice Address - Phone:937-206-1131
Practice Address - Fax:937-917-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3262133V00000X
OH6292261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty