Provider Demographics
NPI:1720684228
Name:BEACHSIDE NUTRITION CONSULTANTS
Entity Type:Organization
Organization Name:BEACHSIDE NUTRITION CONSULTANTS
Other - Org Name:NUTRITION BY BROOKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:MADER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN
Authorized Official - Phone:301-996-2927
Mailing Address - Street 1:29 ETHELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2900
Mailing Address - Country:US
Mailing Address - Phone:301-996-2927
Mailing Address - Fax:
Practice Address - Street 1:414 2ND ST APT 330
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4610
Practice Address - Country:US
Practice Address - Phone:301-996-2927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty