Provider Demographics
NPI:1871108993
Name:VERDIN ENTERPRISES, LLC
Entity type:Organization
Organization Name:VERDIN ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:VERDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:318-245-0235
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:LA
Mailing Address - Zip Code:71048-0201
Mailing Address - Country:US
Mailing Address - Phone:318-245-0235
Mailing Address - Fax:318-548-6460
Practice Address - Street 1:164 PATTONTOWN ROAD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71048
Practice Address - Country:US
Practice Address - Phone:218-245-0235
Practice Address - Fax:318-353-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty