Provider Demographics
NPI:1548932247
Name:NUTRITION REFOCUSED LLC
Entity type:Organization
Organization Name:NUTRITION REFOCUSED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:713-304-8593
Mailing Address - Street 1:1666 SILVER MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80951-3200
Mailing Address - Country:US
Mailing Address - Phone:713-304-8593
Mailing Address - Fax:719-434-9768
Practice Address - Street 1:1666 SILVER MEADOW CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80951-3200
Practice Address - Country:US
Practice Address - Phone:713-304-8593
Practice Address - Fax:719-434-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX894680Medicaid