Provider Demographics
NPI:1851759757
Name:TOTAL LIFE WELLNESS
Entity Type:Organization
Organization Name:TOTAL LIFE WELLNESS
Other - Org Name:DIABETES PREVENTION EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSE ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MSNIH, CHHC
Authorized Official - Phone:301-752-1425
Mailing Address - Street 1:1533 LINCOLN WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1923
Mailing Address - Country:US
Mailing Address - Phone:301-752-1425
Mailing Address - Fax:
Practice Address - Street 1:1533 LINCOLN WAY APT 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1923
Practice Address - Country:US
Practice Address - Phone:301-752-1425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL LIFE WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty