Provider Demographics
NPI:1790330132
Name:SPRING HOUSE NUTRITION, LLC
Entity Type:Organization
Organization Name:SPRING HOUSE NUTRITION, LLC
Other - Org Name:AMBLER NUTRITION, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:FORBES
Authorized Official - Last Name:PUSKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN, CDCES
Authorized Official - Phone:215-527-4193
Mailing Address - Street 1:324 ROSEMARY AVE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4631
Mailing Address - Country:US
Mailing Address - Phone:215-527-4193
Mailing Address - Fax:
Practice Address - Street 1:324 ROSEMARY AVE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-4631
Practice Address - Country:US
Practice Address - Phone:215-527-4193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)