Provider Demographics
NPI:1306163423
Name:NUTRITIONAL CONCERNS, INC
Entity type:Organization
Organization Name:NUTRITIONAL CONCERNS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCRUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:937-367-1291
Mailing Address - Street 1:331 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4013
Mailing Address - Country:US
Mailing Address - Phone:937-367-1291
Mailing Address - Fax:937-648-9880
Practice Address - Street 1:4415 DAYTON LIBERTY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-5903
Practice Address - Country:US
Practice Address - Phone:937-268-6741
Practice Address - Fax:937-268-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF78220172V00000X
OHLD.6525133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty