Healthcare Provider Details

I. General information

NPI: 1417608191
Provider Name (Legal Business Name): EVERYTABLE, PBC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 E VERNON AVE
VERNON CA
90058-1809
US

IV. Provider business mailing address

PO BOX 58048
VERNON CA
90058-0048
US

V. Phone/Fax

Practice location:
  • Phone: 213-444-5524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: CLARE FOX
Title or Position: VICE PRESIDENT,
Credential:
Phone: 818-325-5872