Provider Demographics
NPI:1255773636
Name:NOURISH & RENEW
Entity type:Organization
Organization Name:NOURISH & RENEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:860-997-7900
Mailing Address - Street 1:549 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4441
Mailing Address - Country:US
Mailing Address - Phone:860-997-7900
Mailing Address - Fax:
Practice Address - Street 1:8 HEBRON ROAD, 2ND FLOOR
Practice Address - Street 2:ONEIDA HOLISTIC HEALTH CENTER
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1272
Practice Address - Country:US
Practice Address - Phone:860-467-6518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001160133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty