Provider Demographics
NPI:1902416563
Name:BASH NUTRITION LLC
Entity Type:Organization
Organization Name:BASH NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:954-817-0000
Mailing Address - Street 1:1610 NW 82ND TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4642
Mailing Address - Country:US
Mailing Address - Phone:954-817-0000
Mailing Address - Fax:
Practice Address - Street 1:1610 NW 82ND TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4642
Practice Address - Country:US
Practice Address - Phone:954-817-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty