Provider Demographics
NPI:1902288368
Name:HOUSECALL NUTRITION OF VIRGINIA LLC
Entity Type:Organization
Organization Name:HOUSECALL NUTRITION OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLEKSYN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN,CNSC
Authorized Official - Phone:585-469-6227
Mailing Address - Street 1:105 SEA TRACE CT
Mailing Address - Street 2:APT 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 SEA TRACE CT
Practice Address - Street 2:APT 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4448
Practice Address - Country:US
Practice Address - Phone:585-469-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty