Provider Demographics
NPI:1710752472
Name:GUIDED PATH NUTRITION LLC
Entity Type:Organization
Organization Name:GUIDED PATH NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JUSTYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-327-4756
Mailing Address - Street 1:709 PLAZA DR # 154
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9111 BROADWAY STE D
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7092
Practice Address - Country:US
Practice Address - Phone:219-327-4756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty