Provider Demographics
NPI:1871184028
Name:WHOLE NUTRITION CENTER, LLC
Entity Type:Organization
Organization Name:WHOLE NUTRITION CENTER, LLC
Other - Org Name:MINDFUL MEALS NUTRITION SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:MONK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:201-874-4968
Mailing Address - Street 1:8 ALGONQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866
Mailing Address - Country:US
Mailing Address - Phone:201-874-4968
Mailing Address - Fax:
Practice Address - Street 1:25 PINE ST STE 4
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3143
Practice Address - Country:US
Practice Address - Phone:862-309-9859
Practice Address - Fax:908-509-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-31
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1871184028Medicaid