Provider Demographics
NPI:1982294781
Name:BALANCED ROOTS, LLC
Entity Type:Organization
Organization Name:BALANCED ROOTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN
Authorized Official - Phone:610-739-8440
Mailing Address - Street 1:5199 SPRING RIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9577
Mailing Address - Country:US
Mailing Address - Phone:610-739-8440
Mailing Address - Fax:
Practice Address - Street 1:5199 SPRING RIDGE DR E
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9577
Practice Address - Country:US
Practice Address - Phone:610-739-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty