Provider Demographics
NPI:1770187023
Name:HILARY PEACE RD LLC
Entity Type:Organization
Organization Name:HILARY PEACE RD LLC
Other - Org Name:HILARY LEGGIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-332-8334
Mailing Address - Street 1:215 W PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8450
Mailing Address - Country:US
Mailing Address - Phone:936-332-8334
Mailing Address - Fax:337-201-9883
Practice Address - Street 1:215 W PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8450
Practice Address - Country:US
Practice Address - Phone:936-332-8334
Practice Address - Fax:337-201-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health