Provider Demographics
NPI:1598013773
Name:ATR NUTRITION CENTER LLC
Entity Type:Organization
Organization Name:ATR NUTRITION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRESE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER DIETITIAN
Authorized Official - Phone:215-225-0333
Mailing Address - Street 1:3858 PULASKI AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-3540
Mailing Address - Country:US
Mailing Address - Phone:215-225-0333
Mailing Address - Fax:215-225-0380
Practice Address - Street 1:3858 PULASKI AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-3540
Practice Address - Country:US
Practice Address - Phone:215-225-0333
Practice Address - Fax:215-225-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001597311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility