Provider Demographics
NPI:1194401257
Name:LOUISA O'GRADY NUTRITION LLC
Entity type:Organization
Organization Name:LOUISA O'GRADY NUTRITION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN CDCES
Authorized Official - Phone:203-951-9253
Mailing Address - Street 1:8 HUNTINGTON ST # 111
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5212
Mailing Address - Country:US
Mailing Address - Phone:203-951-9253
Mailing Address - Fax:
Practice Address - Street 1:7 BEACON HILL TERRACE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5212
Practice Address - Country:US
Practice Address - Phone:203-951-9253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty