Healthcare Provider Details

I. General information

NPI: 1922856376
Provider Name (Legal Business Name): NI-KAHCHI PURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 WHITE HORSE PIKE STE 4
HAMMONTON NJ
08037-9649
US

IV. Provider business mailing address

649 WHITE HORSE PIKE STE 3
HAMMONTON NJ
08037-9649
US

V. Phone/Fax

Practice location:
  • Phone: 609-666-5205
  • Fax:
Mailing address:
  • Phone: 609-666-5205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANET CORRENTE
Title or Position: OWNER
Credential:
Phone: 570-793-8588