Provider Demographics
NPI:1619086758
Name:SSS NUTRITION AND DIETETIC CARE SERVICES, INC.
Entity Type:Organization
Organization Name:SSS NUTRITION AND DIETETIC CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CHIEF NUTRITION SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUSOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD, LN
Authorized Official - Phone:301-588-4440
Mailing Address - Street 1:PO BOX 8336
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20907-8336
Mailing Address - Country:US
Mailing Address - Phone:301-588-4440
Mailing Address - Fax:301-588-1011
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 934
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-588-4440
Practice Address - Fax:301-588-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB00222133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD169NMedicare ID - Type UnspecifiedGROUP PROVIDER ID NUMBER