Healthcare Provider Details

I. General information

NPI: 1235824400
Provider Name (Legal Business Name): ALIGNED EATS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N GORE AVE STE 210
WEBSTER GROVES MO
63119-2300
US

IV. Provider business mailing address

269 PALM DR
HAZELWOOD MO
63042-2114
US

V. Phone/Fax

Practice location:
  • Phone: 314-806-7655
  • Fax:
Mailing address:
  • Phone: 314-497-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA RUSSELL
Title or Position: OWNER
Credential: RDN, LD
Phone: 314-497-3367