Provider Demographics
NPI:1588231948
Name:THE NURTURED NEST LL
Entity Type:Organization
Organization Name:THE NURTURED NEST LL
Other - Org Name:THE NURTURED NEST LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:DANAE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:215-251-0463
Mailing Address - Street 1:150 MONUMENT RD STE 207
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1725
Mailing Address - Country:US
Mailing Address - Phone:215-251-0463
Mailing Address - Fax:856-629-0837
Practice Address - Street 1:150 MONUMENT RD STE 207
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1725
Practice Address - Country:US
Practice Address - Phone:215-954-7041
Practice Address - Fax:856-629-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========Medicaid