Healthcare Provider Details

I. General information

NPI: 1962155523
Provider Name (Legal Business Name): HUNGRY HARVEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WITHERS RD
RALEIGH NC
27603-6096
US

IV. Provider business mailing address

1905 CLARKSON WAY
LANDOVER MD
20785-3221
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-4815
  • Fax:
Mailing address:
  • Phone: 443-738-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KALISTA POPP
Title or Position: FINANCE/PROGRAM MANAGER
Credential:
Phone: 443-738-4815