Provider Demographics
NPI:1629675483
Name:FUEL FOR LIFE
Entity Type:Organization
Organization Name:FUEL FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-591-3640
Mailing Address - Street 1:2301 BAGDAD RD STE 404
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6519
Mailing Address - Country:US
Mailing Address - Phone:512-630-0367
Mailing Address - Fax:210-209-8250
Practice Address - Street 1:2301 BAGDAD RD STE 404
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6519
Practice Address - Country:US
Practice Address - Phone:512-630-0367
Practice Address - Fax:210-209-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty