Provider Demographics
NPI:1194175760
Name:RGA DIABETES & NUTRITION, LLC
Entity type:Organization
Organization Name:RGA DIABETES & NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:GROVER
Authorized Official - Last Name:AINSCOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:720-261-7885
Mailing Address - Street 1:6684 S PONTIAC CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4624
Mailing Address - Country:US
Mailing Address - Phone:720-261-7885
Mailing Address - Fax:720-598-1011
Practice Address - Street 1:6684 S PONTIAC CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4624
Practice Address - Country:US
Practice Address - Phone:720-261-7885
Practice Address - Fax:720-598-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center