Provider Demographics
NPI:1841748845
Name:EATING FOR LIFE, LLC
Entity type:Organization
Organization Name:EATING FOR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:480-773-1637
Mailing Address - Street 1:3820 E LEAH CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0013
Mailing Address - Country:US
Mailing Address - Phone:480-773-1637
Mailing Address - Fax:602-362-3171
Practice Address - Street 1:99 S GOLD DR
Practice Address - Street 2:SUITE 6
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-5035
Practice Address - Country:US
Practice Address - Phone:480-773-1637
Practice Address - Fax:602-362-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ956114133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty