Provider Demographics
NPI:1487359998
Name:FARE HEALTH NUTRITION SERVICES LLC
Entity type:Organization
Organization Name:FARE HEALTH NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DARYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROPENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-855-8733
Mailing Address - Street 1:450 CENTURY PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8136
Mailing Address - Country:US
Mailing Address - Phone:972-855-8733
Mailing Address - Fax:
Practice Address - Street 1:450 CENTURY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8136
Practice Address - Country:US
Practice Address - Phone:972-855-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty