NPIViewer - Provider NPI 1093834020

NPI:	1093834020
Name:	PURFOODS, LLC
Entity type:	Organization
Organization Name:	PURFOODS, LLC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	SVP SALES & BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:	NATHAN
Authorized Official - Middle Name:	J
Authorized Official - Last Name:	JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	866-716-3257
Mailing Address - Street 1:	3210 SE CORPORATE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:	ANKENY
Mailing Address - State:	IA
Mailing Address - Zip Code:	50021-2502
Mailing Address - Country:	US
Mailing Address - Phone:	515-963-0641
Mailing Address - Fax:	515-266-6120
Practice Address - Street 1:	3210 SE CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:	ANKENY
Practice Address - State:	IA
Practice Address - Zip Code:	50021-2502
Practice Address - Country:	US
Practice Address - Phone:	515-963-0641
Practice Address - Fax:	515-266-6120
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2007-03-29
Last Update Date:	2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
		133V00000X
IA	0196501	332U00000X

Primary?	Code	Type	Classification	Specialization	Group
Yes	332U00000X	Suppliers	Home Delivered Meals
No	133V00000X	Dietary & Nutritional Service Providers	Dietitian, Registered		Group - Multi-Specialty

State	Identifier ID	ID Type
WI	100292728	Medicaid
OH	2772316	Medicaid
SC	EX0951	Medicaid
NM	00705268	Medicaid
WY	127458900	Medicaid
KS	200629550A	Medicaid
DE	250524302	Medicaid
AZ	274676	Medicaid
VA	30015057200002	Medicaid
MN	086462000	Medicaid
ND	39839	Medicaid
IL	6050138	Medicaid
TN	H445168	Medicaid
TX	S500410290	Medicaid
GA	003105053A	Medicaid
IA	019650	Medicaid
PA	102383905-0002	Medicaid
HI	800401	Medicaid
CO	88807550	Medicaid
IN	200925420A	Medicaid
FL	001653400	Medicaid
ID	1093834020	Medicaid
NC	1093834020	Medicaid
AR	189865753	Medicaid
LA	2163051	Medicaid
OR	500842976	Medicaid
MD	6639038-00	Medicaid
MI	1093832040	Medicaid
NV	1093834020	Medicaid
MT	1093834020	Medicaid
MA	110209233A	Medicaid
OK	200536020 A	Medicaid
NE	99029673	Medicaid
UT	1093834020	Medicaid
NJ	1093834020	Medicaid
KY	7100774160	Medicaid