Provider Demographics
NPI:1962279257
Name:BALANCED ELEMENTS NUTRITION LLC
Entity type:Organization
Organization Name:BALANCED ELEMENTS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:AMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:774-289-1450
Mailing Address - Street 1:99 PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1775
Mailing Address - Country:US
Mailing Address - Phone:774-289-1450
Mailing Address - Fax:
Practice Address - Street 1:99 PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:MA
Practice Address - Zip Code:01543-1775
Practice Address - Country:US
Practice Address - Phone:774-289-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty