Provider Demographics
NPI:1740389220
Name:SREANSIS, LLC
Entity Type:Organization
Organization Name:SREANSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDERS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:410-833-8566
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1384
Mailing Address - Country:US
Mailing Address - Phone:410-833-8566
Mailing Address - Fax:410-833-8566
Practice Address - Street 1:34 BRAMPTON CT
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6432
Practice Address - Country:US
Practice Address - Phone:410-833-8566
Practice Address - Fax:410-833-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02163133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty