Provider Demographics
NPI:1871781831
Name:CCNC NUTRITION, LLC.
Entity type:Organization
Organization Name:CCNC NUTRITION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED & LICESNED DIETITIAN, OW
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:CAESAR
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:713-242-1122
Mailing Address - Street 1:19010 SPRING MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3820
Mailing Address - Country:US
Mailing Address - Phone:713-242-1122
Mailing Address - Fax:866-450-4726
Practice Address - Street 1:17121 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1259
Practice Address - Country:US
Practice Address - Phone:713-242-1122
Practice Address - Fax:866-450-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06856133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty