1477925949 NPI number — ATTUNED EATING AND LIVING CENTER, LLC

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 1477925949 NPI number — ATTUNED EATING AND LIVING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATTUNED EATING AND LIVING CENTER, LLC
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:
6
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:
1477925949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 366
Provider Second Line Business Mailing Address:
70 MAIN STREET
Provider Business Mailing Address City Name:
LUDLOW
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05149-0366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-975-0435
Provider Business Mailing Address Fax Number:
802-975-0418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUDLOW
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05149-0366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-975-0435
Provider Business Practice Location Address Fax Number:
802-975-0418
Provider Enumeration Date:
10/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
KARI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CLINICAL DIRECTOR
Authorized Official Telephone Number:
802-975-0435

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  068.0107790 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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