1619086758 NPI number — SSS NUTRITION AND DIETETIC CARE SERVICES, INC.

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 1619086758 NPI number — SSS NUTRITION AND DIETETIC CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSS NUTRITION AND DIETETIC CARE SERVICES, INC.
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:
1619086758
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:
PO BOX 8336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20907-8336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-588-4440
Provider Business Mailing Address Fax Number:
301-588-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8630 FENTON ST
Provider Second Line Business Practice Location Address:
SUITE 934
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-588-4440
Provider Business Practice Location Address Fax Number:
301-588-1011
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IDOWU
Authorized Official First Name:
OLUSOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/CHIEF NUTRITION SPECIALIST
Authorized Official Telephone Number:
301-588-4440

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  B00222 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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