Provider Demographics
NPI:1811390297
Name:BALANCED LIVING INCORPORATED
Entity Type:Organization
Organization Name:BALANCED LIVING INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:CDN
Authorized Official - Phone:718-544-4036
Mailing Address - Street 1:136-81 71ST ROAD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1942
Mailing Address - Country:US
Mailing Address - Phone:718-544-4036
Mailing Address - Fax:718-544-4036
Practice Address - Street 1:136-81 71ST ROAD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1942
Practice Address - Country:US
Practice Address - Phone:718-544-4036
Practice Address - Fax:718-544-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty