Provider Demographics
NPI:1851777866
Name:HEALING LIFESTYLE CENTER, INC
Entity Type:Organization
Organization Name:HEALING LIFESTYLE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,RDN,LD
Authorized Official - Phone:843-957-4457
Mailing Address - Street 1:11945 GRANDHAVEN DR
Mailing Address - Street 2:STE G
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8091
Mailing Address - Country:US
Mailing Address - Phone:843-839-9088
Mailing Address - Fax:888-909-5897
Practice Address - Street 1:11945 GRANDHAVEN DR
Practice Address - Street 2:STE G
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8091
Practice Address - Country:US
Practice Address - Phone:843-839-9088
Practice Address - Fax:888-909-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty