MEDICARE: HORIZON WEST NUTRITION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND7000	FL

General Provider Information

NPI Number	:	1740772508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON WEST NUTRITION SERVICES, LLC

Provider Business Mailing Address
First Line	:	14388 BLACK QUILL DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14388 BLACK QUILL DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5158
Country	:	US
Telephone Number	:	407-505-9250
Fax Number	:

Authorized Official
Title or Position	:	MANAGING OWNER
Name	:	JENNIFER BEERY
Credential	:	RDN, LDN
Telephone Number	:	407-505-9250

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/06/2018

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