Provider Demographics
NPI:1902403454
Name:JACQUELINE ROBILLIARD RD CDE LLC NUTRITION CARE CENTER
Entity Type:Organization
Organization Name:JACQUELINE ROBILLIARD RD CDE LLC NUTRITION CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDE
Authorized Official - Phone:207-622-0822
Mailing Address - Street 1:219 CONY RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-0502
Mailing Address - Country:US
Mailing Address - Phone:207-622-0822
Mailing Address - Fax:207-512-8663
Practice Address - Street 1:219 CONY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0502
Practice Address - Country:US
Practice Address - Phone:207-622-0822
Practice Address - Fax:207-512-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty