Provider Demographics
NPI:1649421512
Name:EAT TO GROW, INC.
Entity Type:Organization
Organization Name:EAT TO GROW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CLC, CD
Authorized Official - Phone:217-280-0220
Mailing Address - Street 1:306 OSTEEN LN
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-5007
Mailing Address - Country:US
Mailing Address - Phone:217-280-0220
Mailing Address - Fax:217-483-6891
Practice Address - Street 1:306 OSTEEN LN
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-5007
Practice Address - Country:US
Practice Address - Phone:217-280-0220
Practice Address - Fax:217-483-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJM99120799P252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency