Provider Demographics
NPI:1194333211
Name:BEYOND NUTRITION CO LLC
Entity type:Organization
Organization Name:BEYOND NUTRITION CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKROTH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:904-238-4853
Mailing Address - Street 1:633 E MAIN ST UNIT 558
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-4711
Mailing Address - Country:US
Mailing Address - Phone:904-238-4853
Mailing Address - Fax:
Practice Address - Street 1:1949 GOLDSMITH LN STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3096
Practice Address - Country:US
Practice Address - Phone:904-238-4853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty