Provider Demographics
NPI:1881825610
Name:NEW LIFE NUTRITION
Entity Type:Organization
Organization Name:NEW LIFE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOFSESS
Authorized Official - Suffix:
Authorized Official - Credentials:MSRDLD
Authorized Official - Phone:330-726-2440
Mailing Address - Street 1:888 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE I.
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4276
Mailing Address - Country:US
Mailing Address - Phone:330-726-2440
Mailing Address - Fax:330-726-6844
Practice Address - Street 1:888 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE I.
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4276
Practice Address - Country:US
Practice Address - Phone:330-726-2440
Practice Address - Fax:330-726-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2178133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty