Provider Demographics
NPI:1629425160
Name:GRANT'S NUTRITION AND WELLNESS
Entity Type:Organization
Organization Name:GRANT'S NUTRITION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:860-357-2282
Mailing Address - Street 1:37 WEBSTER SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2326
Mailing Address - Country:US
Mailing Address - Phone:860-357-2282
Mailing Address - Fax:860-357-2555
Practice Address - Street 1:37 WEBSTER SQUARE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2326
Practice Address - Country:US
Practice Address - Phone:860-357-2282
Practice Address - Fax:860-357-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1199133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty