Provider Demographics
NPI:1285414771
Name:R3CREATE LLC
Entity type:Organization
Organization Name:R3CREATE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:909-229-9174
Mailing Address - Street 1:11828 BRIARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3936
Mailing Address - Country:US
Mailing Address - Phone:909-229-9174
Mailing Address - Fax:
Practice Address - Street 1:11828 BRIARWOOD CT
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3936
Practice Address - Country:US
Practice Address - Phone:909-229-9174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No174200000XOther Service ProvidersMealsGroup - Single Specialty