Basic Information
| Provider Information | |||||||||
| NPI: | 1619132966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LITE-WEIGHS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 242 CAJON ST | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923735202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093354118 | ||||||||
| FaxNumber: | 9097931125 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 W FERN AVE | ||||||||
| Address2: | SUITE U | ||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923735916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097933311 | ||||||||
| FaxNumber: | 9097931125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 07/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | CRAMER | ||||||||
| AuthorizedOfficialFirstName: | SYLVIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9097931174 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 132700000X | 19340008 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietary Manager |
No ID Information.