Provider Demographics
NPI:1487859559
Name:BALANCED NOURISHMENT
Entity Type:Organization
Organization Name:BALANCED NOURISHMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARIGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-306-3722
Mailing Address - Street 1:66 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1518
Mailing Address - Country:US
Mailing Address - Phone:860-306-3722
Mailing Address - Fax:
Practice Address - Street 1:66 LAUREL LN
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1518
Practice Address - Country:US
Practice Address - Phone:860-306-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48892606133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty