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General NPI Number Information
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NPI Number | 1598013773
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Entity Type | Organization
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Legal Business Name | ATR NUTRITION CENTER LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 3858 PULASKI AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-3540
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Country | US
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Telephone | 215-225-0333
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Fax | 215-225-0380
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Provider Business Mailing Address
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Address Line | 3858 PULASKI AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-3540
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Country | US
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Telephone | 215-225-0333
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Fax | 215-225-0380
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. TERRESE G RICE
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Credential | REGISTER DIETITIAN
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Telephone | 215-225-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | DN001597
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License Number State | PA
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