Healthcare Provider Details

I. General information

NPI: 1871416933
Provider Name (Legal Business Name): WHOLE LIFE RENAL NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 FIRE TOWER RD
SALLEY SC
29137-9622
US

IV. Provider business mailing address

2633 FIRE TOWER RD
SALLEY SC
29137-9622
US

V. Phone/Fax

Practice location:
  • Phone: 585-747-8202
  • Fax:
Mailing address:
  • Phone: 585-747-8202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: APRIL GROSS
Title or Position: OWNER
Credential: RD
Phone: 585-747-8202