Provider Demographics
NPI:1801372016
Name:ACTIVE FUELING LLC
Entity Type:Organization
Organization Name:ACTIVE FUELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPORTS DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CSSD
Authorized Official - Phone:303-885-4161
Mailing Address - Street 1:7900 E UNION AVE STE 1136
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2735
Mailing Address - Country:US
Mailing Address - Phone:303-885-4161
Mailing Address - Fax:
Practice Address - Street 1:7900 E UNION AVE STE 1136
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2735
Practice Address - Country:US
Practice Address - Phone:303-885-4161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1017986133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty