Provider Demographics
NPI:1124860333
Name:LONGFELLOW WELLESLEY THC, LLC
Entity type:Organization
Organization Name:LONGFELLOW WELLESLEY THC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NUTRITION DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:POLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD, LDN
Authorized Official - Phone:508-653-4633
Mailing Address - Street 1:140 GREAT PLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 GREAT PLAIN AVE
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7208
Practice Address - Country:US
Practice Address - Phone:508-653-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty