Organization
MOUNTAIN HOME NUTRITION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA J MOULTON RD,LD (OWNER)
(208) 590-9348
Entity
Organization
Contact information
Practice address
285 E 4TH N, MOUNTAIN HOME, ID 83647
(208) 590-0858
Mailing address
285 E 4TH N, MOUNTAIN HOME, ID 83647-2716
(208) 590-0858
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-039
ID
Other
Enumeration date
06/25/2018
Last updated
09/11/2018
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