Provider Demographics
NPI:1760817878
Name:ROCHE NUTRITION, INC.
Entity Type:Organization
Organization Name:ROCHE NUTRITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CD
Authorized Official - Phone:317-850-8497
Mailing Address - Street 1:3031 GORHAM COURT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3280
Mailing Address - Country:US
Mailing Address - Phone:317-850-8497
Mailing Address - Fax:317-848-6373
Practice Address - Street 1:3031 GORHAM CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-3280
Practice Address - Country:US
Practice Address - Phone:317-850-8497
Practice Address - Fax:317-848-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000123A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty