1669954137 NPI number — FOOD CENTERED SOLUTIONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669954137 NPI number — FOOD CENTERED SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOD CENTERED SOLUTIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669954137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
829 E DOTY BRANCH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOHNS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32259-5474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-562-0082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 OSCEOLA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAX BCH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-562-0082
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SIVER
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
REGISTERED DIETITIAN NUTRITIONIST
Authorized Official Telephone Number:
904-562-0082

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  7102 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86029715 . This is a "ACADEMY OF NUTRITION AND DIETETICS" identifier . This identifiers is of the category "OTHER".




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