Provider Demographics
NPI:1922164821
Name:NUTRITIONAL CARE LLC
Entity Type:Organization
Organization Name:NUTRITIONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-776-0001
Mailing Address - Street 1:845 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2521
Mailing Address - Country:US
Mailing Address - Phone:870-776-0001
Mailing Address - Fax:800-625-7715
Practice Address - Street 1:845 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2521
Practice Address - Country:US
Practice Address - Phone:870-776-0001
Practice Address - Fax:800-625-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49870OtherAR BSBS
AR4793070001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER