Provider Demographics
NPI:1992151930
Name:FOOD IS MEDICINE RD LLC
Entity type:Organization
Organization Name:FOOD IS MEDICINE RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD
Authorized Official - Phone:860-280-6297
Mailing Address - Street 1:667 S 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3459
Mailing Address - Country:US
Mailing Address - Phone:860-280-6297
Mailing Address - Fax:172-024-7923
Practice Address - Street 1:667 S 22ND AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3459
Practice Address - Country:US
Practice Address - Phone:860-280-6297
Practice Address - Fax:172-024-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO859029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
859029OtherACADEMY OF NUTRITION AND DIETETICS