Provider Demographics
NPI:1457940108
Name:FOOD 4 SUCCESS
Entity Type:Organization
Organization Name:FOOD 4 SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUECKEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:210-439-1714
Mailing Address - Street 1:743 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4333
Mailing Address - Country:US
Mailing Address - Phone:210-439-1714
Mailing Address - Fax:830-730-5652
Practice Address - Street 1:2115 STEPHENS PL STE 400B
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2167
Practice Address - Country:US
Practice Address - Phone:210-439-1714
Practice Address - Fax:830-730-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT81691OtherLD