Provider Demographics
NPI:1629767314
Name:KILLION FAMILY NUTRITION, LLC
Entity Type:Organization
Organization Name:KILLION FAMILY NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLION
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDN
Authorized Official - Phone:978-846-1092
Mailing Address - Street 1:63 CATHARINE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2809
Mailing Address - Country:US
Mailing Address - Phone:978-846-1092
Mailing Address - Fax:
Practice Address - Street 1:3 SALEM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-799-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service