Provider Demographics
NPI:1265885529
Name:THE FEARLESS FORK, INC.
Entity type:Organization
Organization Name:THE FEARLESS FORK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS RDN, CSR, LD
Authorized Official - Phone:207-752-2341
Mailing Address - Street 1:21 SCHOOL HOUSE RD STE 14
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04472-3966
Mailing Address - Country:US
Mailing Address - Phone:297-752-2341
Mailing Address - Fax:855-752-0261
Practice Address - Street 1:21 SCHOOL HOUSE RD STE 14
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:ME
Practice Address - Zip Code:04472-3966
Practice Address - Country:US
Practice Address - Phone:207-752-2341
Practice Address - Fax:207-702-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty