Provider Demographics
NPI:1659139129
Name:THE FARM FRESH RD LLC
Entity Type:Organization
Organization Name:THE FARM FRESH RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD, CD, FAND
Authorized Official - Phone:715-495-2398
Mailing Address - Street 1:W2403 FOX COULEE RD
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:WI
Mailing Address - Zip Code:54756-8000
Mailing Address - Country:US
Mailing Address - Phone:715-495-2398
Mailing Address - Fax:
Practice Address - Street 1:W2403 FOX COULEE RD
Practice Address - Street 2:
Practice Address - City:NELSON
Practice Address - State:WI
Practice Address - Zip Code:54756-8000
Practice Address - Country:US
Practice Address - Phone:715-495-2398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health