Provider Demographics
NPI:1689341844
Name:HEALTHY SOUL KITCHEN LLC
Entity Type:Organization
Organization Name:HEALTHY SOUL KITCHEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KELSON
Authorized Official - Last Name:ALEXIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-408-9415
Mailing Address - Street 1:13275 RUE MAISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6562
Mailing Address - Country:US
Mailing Address - Phone:225-408-9415
Mailing Address - Fax:
Practice Address - Street 1:13275 RUE MAISON BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6562
Practice Address - Country:US
Practice Address - Phone:225-408-9415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals