Healthcare Provider Details

I. General information

NPI: 1891155974
Provider Name (Legal Business Name): HRMC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 06/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MESQUITE AVE SUITE 202
LAKE HAVASU CITY AZ
86403-5677
US

IV. Provider business mailing address

1851 MESQUITE AVE SUITE 202
LAKE HAVASU CITY AZ
86403-5677
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-0094
  • Fax: 928-680-8986
Mailing address:
  • Phone: 928-854-0094
  • Fax: 928-680-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8464
License Number StateAZ

VIII. Authorized Official

Name: JESS JUDY
Title or Position: VP
Credential:
Phone: 928-854-0094