Provider Demographics
NPI:1760054449
Name:VILLAGE NUTRITION LLC
Entity Type:Organization
Organization Name:VILLAGE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILREIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDN, LDN
Authorized Official - Phone:413-214-2233
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-0218
Mailing Address - Country:US
Mailing Address - Phone:413-214-2233
Mailing Address - Fax:
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01518-1213
Practice Address - Country:US
Practice Address - Phone:413-214-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center