Provider Demographics
NPI:1922674977
Name:CHRISSY CRAWFORD NUTRITIONIST FITNESS & THERAPEUTIC HEALTH CENTER L.L.
Entity Type:Organization
Organization Name:CHRISSY CRAWFORD NUTRITIONIST FITNESS & THERAPEUTIC HEALTH CENTER L.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEART DISEASE AND DIABETES
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:856-208-6126
Mailing Address - Street 1:6054 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6210
Mailing Address - Country:US
Mailing Address - Phone:609-380-2492
Mailing Address - Fax:
Practice Address - Street 1:900 RTE. 168 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-208-6126
Practice Address - Fax:856-677-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty