Healthcare Provider Details

I. General information

NPI: 1013964881
Provider Name (Legal Business Name): NUTRITION CARE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 DAVIS RD SUITE 121
ELGIN IL
60123-1304
US

IV. Provider business mailing address

1275 DAVIS RD SUITE 121
ELGIN IL
60123-1304
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-8177
  • Fax: 847-888-8178
Mailing address:
  • Phone: 847-888-8177
  • Fax: 847-888-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. DOROTHY M. STEWART
Title or Position: PRESIDENT
Credential: R.D., LDN
Phone: 847-888-8177