Provider Demographics
NPI:1336756493
Name:BALANCED NUTRITION LLC
Entity Type:Organization
Organization Name:BALANCED NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:860-214-7759
Mailing Address - Street 1:95 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4920
Mailing Address - Country:US
Mailing Address - Phone:860-214-7759
Mailing Address - Fax:
Practice Address - Street 1:1224 MILL ST
Practice Address - Street 2:BUILDING B OFFICE 227C
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1159
Practice Address - Country:US
Practice Address - Phone:860-351-3144
Practice Address - Fax:833-734-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty