Healthcare Provider Details

I. General information

NPI: 1902188568
Provider Name (Legal Business Name): HEALTHCARE DINING SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 N YORK ST SUITE 20
MUSKOGEE OK
74403-3123
US

IV. Provider business mailing address

928 N YORK ST SUITE 20
MUSKOGEE OK
74403-3123
US

V. Phone/Fax

Practice location:
  • Phone: 918-913-9109
  • Fax: 918-913-9112
Mailing address:
  • Phone: 918-913-9109
  • Fax: 918-913-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TONYA L BRADFORD
Title or Position: PRESIDENT CEO
Credential: MS, CCC-SLP
Phone: 918-913-9109