Provider Demographics
NPI:1912382938
Name:NOURISH COACHES
Entity Type:Organization
Organization Name:NOURISH COACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:732-945-9915
Mailing Address - Street 1:252 MAPLE AVE
Mailing Address - Street 2:WIKOFF BUILDING
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1731
Mailing Address - Country:US
Mailing Address - Phone:732-945-9915
Mailing Address - Fax:
Practice Address - Street 1:252 MAPLE AVE
Practice Address - Street 2:WIKOFF BUILDING
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1731
Practice Address - Country:US
Practice Address - Phone:732-945-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty