Provider Demographics
NPI:1811324197
Name:SENIOR NUTRITION SERVICES REGION IV
Entity type:Organization
Organization Name:SENIOR NUTRITION SERVICES REGION IV
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-925-0137
Mailing Address - Street 1:1708 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-6709
Mailing Address - Country:US
Mailing Address - Phone:269-925-0137
Mailing Address - Fax:269-925-0557
Practice Address - Street 1:1708 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6709
Practice Address - Country:US
Practice Address - Phone:269-925-0137
Practice Address - Fax:269-925-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No335G00000XSuppliersMedical Foods Supplier