Organization
EAT WELL FOR LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI LUCAS RD, LDN (OWNER/REGISTERED DIETITIAN)
(717) 372-6687
Entity
Organization
Contact information
Practice address
35 RAGGED EDGE RD, CHAMBERSBURG, PA 17202-4450
(717) 372-6687
(717) 446-0033
Mailing address
138 ROLAND AVE, CHAMBERSBURG, PA 17201-1444
(717) 372-6687
(717) 446-0033
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T1434218103
CERTIFICATE OF ORGANIZATION
PA
Enumeration date
01/02/2015
Last updated
01/13/2016
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