1891743597 NPI number — LOVE R US CHILD AND NUTRITION SERVICES

Table of content: (NPI 1891743597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891743597 NPI number — LOVE R US CHILD AND NUTRITION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOVE R US CHILD AND NUTRITION SERVICES
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:
MEDICAL NUTRITION THERAPY CONSULTANT SERVICES
Provider Other Organization Name Type Code:
3
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:
1891743597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1403 ESSEX CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYMORE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64083-9091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-331-2044
Provider Business Mailing Address Fax Number:
816-767-0925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10500 GRANDVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64137-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-767-0925
Provider Business Practice Location Address Fax Number:
816-767-0925
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
AISHA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRRESIDENT
Authorized Official Telephone Number:
816-965-0652

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  2004034948 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com