Provider Demographics
NPI:1174859607
Name:A COACH FOR ME
Entity Type:Organization
Organization Name:A COACH FOR ME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDEE
Authorized Official - Middle Name:PHYLLIS
Authorized Official - Last Name:VAN NESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-510-6313
Mailing Address - Street 1:4740 FLINTRIDGE DR
Mailing Address - Street 2:STE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4253
Mailing Address - Country:US
Mailing Address - Phone:719-510-6313
Mailing Address - Fax:
Practice Address - Street 1:4740 FLINTRIDGE DR
Practice Address - Street 2:STE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4253
Practice Address - Country:US
Practice Address - Phone:719-510-6313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty