Provider Demographics
NPI:1841621810
Name:ANNEX NUTRITION SERVICES, INC
Entity type:Organization
Organization Name:ANNEX NUTRITION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPH, CDN
Authorized Official - Phone:863-588-2652
Mailing Address - Street 1:450 JAY CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4421
Mailing Address - Country:US
Mailing Address - Phone:863-588-2652
Mailing Address - Fax:914-345-0858
Practice Address - Street 1:450 JAY CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4421
Practice Address - Country:US
Practice Address - Phone:863-588-2652
Practice Address - Fax:914-345-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6051251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health