Healthcare Provider Details

I. General information

NPI: 1033725593
Provider Name (Legal Business Name): THE HEALTHY SCHOOL FOOD COLLABORATIVE 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LOYOLA AVE STE 403
NEW ORLEANS LA
70113-1912
US

IV. Provider business mailing address

701 LOYOLA AVE STE 403
NEW ORLEANS LA
70113-1912
US

V. Phone/Fax

Practice location:
  • Phone: 985-285-1593
  • Fax: 504-324-0507
Mailing address:
  • Phone: 985-285-1593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JAMES ARTHUR GRAHAM JR.
Title or Position: CEO
Credential: JD
Phone: 985-285-1593