Provider Demographics
NPI:1811648470
Name:BE BALANCED NUTRITION SERVICES
Entity type:Organization
Organization Name:BE BALANCED NUTRITION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:727-204-4153
Mailing Address - Street 1:17637 TIMBERLINE PKWY
Mailing Address - Street 2:
Mailing Address - City:BABCOCK RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:33982-5047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17637 TIMBERLINE PKWY
Practice Address - Street 2:
Practice Address - City:BABCOCK RANCH
Practice Address - State:FL
Practice Address - Zip Code:33982-5047
Practice Address - Country:US
Practice Address - Phone:727-204-4153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center