Provider Demographics
NPI:1760850390
Name:MCDONOUGH NUTRITIONAL SERVICES
Entity type:Organization
Organization Name:MCDONOUGH NUTRITIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIBIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MS LC
Authorized Official - Phone:202-509-6991
Mailing Address - Street 1:6827 4TH ST NW
Mailing Address - Street 2:#104
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1900
Mailing Address - Country:US
Mailing Address - Phone:202-509-6991
Mailing Address - Fax:
Practice Address - Street 1:6827 4TH ST NW
Practice Address - Street 2:#104
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1900
Practice Address - Country:US
Practice Address - Phone:202-509-6991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNU89133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC083550100Medicaid