Provider Demographics
NPI:1861817520
Name:PATTY RAIS-KEELEY RD, LDN, CDE, LLC
Entity Type:Organization
Organization Name:PATTY RAIS-KEELEY RD, LDN, CDE, LLC
Other - Org Name:PATRICIA RAIS-KEELEY RD, LDN, CDE, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIS-KEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, CDE
Authorized Official - Phone:617-365-8257
Mailing Address - Street 1:14 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1520
Mailing Address - Country:US
Mailing Address - Phone:617-365-8257
Mailing Address - Fax:781-444-0079
Practice Address - Street 1:220-1 RESERVOIR ST.
Practice Address - Street 2:
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:617-365-8257
Practice Address - Fax:781-444-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA292133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty