Provider Demographics
NPI:1770205056
Name:HALCYON HEALTH
Entity type:Organization
Organization Name:HALCYON HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:901-238-8466
Mailing Address - Street 1:3002 NE 5TH TER APT 213B
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2071
Mailing Address - Country:US
Mailing Address - Phone:901-238-8466
Mailing Address - Fax:833-734-1635
Practice Address - Street 1:3002 NE 5TH TER APT 213B
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33334-2071
Practice Address - Country:US
Practice Address - Phone:901-238-8466
Practice Address - Fax:833-734-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty