Provider Demographics
NPI:1346767548
Name:NOURISHED RECOVERY OF SAVANNAH, LLC
Entity Type:Organization
Organization Name:NOURISHED RECOVERY OF SAVANNAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIEKE
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-659-9038
Mailing Address - Street 1:127 ABERCORN ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-4069
Mailing Address - Country:US
Mailing Address - Phone:912-659-9038
Mailing Address - Fax:
Practice Address - Street 1:127 ABERCORN ST STE 403
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-4069
Practice Address - Country:US
Practice Address - Phone:912-660-1841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty