Provider Demographics
NPI:1093524746
Name:CAROLINA NUTRITIONAL SERVICES LLC
Entity type:Organization
Organization Name:CAROLINA NUTRITIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:828-736-4905
Mailing Address - Street 1:190 BOBCAT TRL
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-9443
Mailing Address - Country:US
Mailing Address - Phone:828-736-4905
Mailing Address - Fax:
Practice Address - Street 1:190 BOBCAT TRL
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9443
Practice Address - Country:US
Practice Address - Phone:828-736-4905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty