Provider Demographics
NPI:1255144549
Name:ROOM AT THE TABLE NUTRITION SERVICES LLC
Entity type:Organization
Organization Name:ROOM AT THE TABLE NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:540-241-5920
Mailing Address - Street 1:37 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-2700
Mailing Address - Country:US
Mailing Address - Phone:540-241-5920
Mailing Address - Fax:
Practice Address - Street 1:37 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-2700
Practice Address - Country:US
Practice Address - Phone:540-241-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty