Provider Demographics
NPI:1699168211
Name:RIVER NORTH NUTRITION LLC
Entity type:Organization
Organization Name:RIVER NORTH NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, LDN
Authorized Official - Phone:916-667-2020
Mailing Address - Street 1:10 E ONTARIO ST
Mailing Address - Street 2:UNIT 4506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2736
Mailing Address - Country:US
Mailing Address - Phone:872-225-0838
Mailing Address - Fax:
Practice Address - Street 1:10 E ONTARIO ST
Practice Address - Street 2:UNIT 4506
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2736
Practice Address - Country:US
Practice Address - Phone:872-225-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty