Provider Demographics
NPI:1194106880
Name:DIETARY MANAGE IN-SERVICE TRAINING AND STAFFING, INC.
Entity type:Organization
Organization Name:DIETARY MANAGE IN-SERVICE TRAINING AND STAFFING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:L. DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:EDUCATION SPECIALIST
Authorized Official - Phone:225-620-6219
Mailing Address - Street 1:1500 LAFAYETTE ST STE 107A
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5732
Mailing Address - Country:US
Mailing Address - Phone:504-510-4798
Mailing Address - Fax:
Practice Address - Street 1:11715 BRICKSOME AVE
Practice Address - Street 2:SUITE B-8
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2307
Practice Address - Country:US
Practice Address - Phone:225-620-6219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services