Provider Demographics
NPI:1730336975
Name:RL NUTRITION SERVICES
Entity type:Organization
Organization Name:RL NUTRITION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOUDERMELT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, RD, LD, CDE
Authorized Official - Phone:606-258-2777
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-0698
Mailing Address - Country:US
Mailing Address - Phone:606-215-6352
Mailing Address - Fax:877-792-5105
Practice Address - Street 1:475 N HIGHWAY 25 W
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1576
Practice Address - Country:US
Practice Address - Phone:606-215-6352
Practice Address - Fax:877-792-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2083261QH0100X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11896924OtherCAQH
KY11896924OtherCAQH