Provider Demographics
NPI:1730665779
Name:NUTRITION FOR YOU LLC
Entity Type:Organization
Organization Name:NUTRITION FOR YOU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDLDN
Authorized Official - Phone:501-730-4179
Mailing Address - Street 1:1103 RED ROCK RNCH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4435
Mailing Address - Country:US
Mailing Address - Phone:501-730-2292
Mailing Address - Fax:
Practice Address - Street 1:1103 RED ROCK RNCH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-4435
Practice Address - Country:US
Practice Address - Phone:501-730-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care