Provider Demographics
NPI:1679386809
Name:QUEEN CITY ENTERPRISES
Entity type:Organization
Organization Name:QUEEN CITY ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC NUTRITIONIST COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ASET
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUST
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:951-553-3051
Mailing Address - Street 1:6163 VERMILION LOOP
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-3261
Mailing Address - Country:US
Mailing Address - Phone:951-553-3051
Mailing Address - Fax:
Practice Address - Street 1:823 BROAD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1214
Practice Address - Country:US
Practice Address - Phone:951-553-3051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEEN CITY ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals