Provider Demographics
NPI:1780200147
Name:NOURISH360 LLC
Entity Type:Organization
Organization Name:NOURISH360 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:610-635-9942
Mailing Address - Street 1:117 MAHOGANY LN
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2299
Mailing Address - Country:US
Mailing Address - Phone:610-635-9942
Mailing Address - Fax:
Practice Address - Street 1:117 MAHOGANY LN
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2299
Practice Address - Country:US
Practice Address - Phone:610-635-9942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty