Provider Demographics
NPI:1396353561
Name:360GIRLS&WOMEN
Entity type:Organization
Organization Name:360GIRLS&WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SUE-ELLEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANDERSON-HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RDN,CDCES, LDN
Authorized Official - Phone:352-871-3022
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-0792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 GRANITE ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-2301
Practice Address - Country:US
Practice Address - Phone:352-871-3022
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
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty