Provider Demographics
NPI:1831716919
Name:UPBEET NUTRITION LLC
Entity type:Organization
Organization Name:UPBEET NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:GRAY DELOACHE
Authorized Official - Last Name:TOLLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:803-374-3021
Mailing Address - Street 1:1129 SHADY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9016
Mailing Address - Country:US
Mailing Address - Phone:803-374-3021
Mailing Address - Fax:
Practice Address - Street 1:1129 SHADY GROVE LN
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9016
Practice Address - Country:US
Practice Address - Phone:803-374-3021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty