MEDICARE: HUNTSVILLE NUTRITION COLLECTIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1780200824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTSVILLE NUTRITION COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	202 HUGHES POND CIR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-7372
Country	:	US
Telephone Number	:	256-783-9530
Fax Number	:

Provider Business Practice Location Address
First Line	:	7738B MADISON BLVD STE 204
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-3661
Country	:	US
Telephone Number	:	256-224-1665
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIETITIAN
Name	:	CHELSEA EDWARDS
Credential	:	RD
Telephone Number	:	256-224-1665

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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