Provider Demographics
NPI:1346076221
Name:NUTRICENTER LLC
Entity type:Organization
Organization Name:NUTRICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FUNCTIONAL NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPENWIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:970-616-9616
Mailing Address - Street 1:36002 N TOM DARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-4124
Mailing Address - Country:US
Mailing Address - Phone:970-616-9616
Mailing Address - Fax:
Practice Address - Street 1:36002 N TOM DARLINGTON DR
Practice Address - Street 2:
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377-4124
Practice Address - Country:US
Practice Address - Phone:970-616-9616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service