Healthcare Provider Details

I. General information

NPI: 1306163423
Provider Name (Legal Business Name): NUTRITIONAL CONCERNS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 DAYTON LIBERTY RD
DAYTON OH
45417-5903
US

IV. Provider business mailing address

331 KENWOOD AVE
DAYTON OH
45405-4013
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6741
  • Fax: 937-268-6804
Mailing address:
  • Phone: 937-367-1291
  • Fax: 937-648-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.6525
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberF78220
License Number StateOH

VIII. Authorized Official

Name: ALBERTA M SCRUGGS
Title or Position: DIRECTOR
Credential: L.D.
Phone: 937-367-1291