Provider Demographics
NPI:1811160666
Name:RENAISSANCE NUTRITION CENTER, INC
Entity type:Organization
Organization Name:RENAISSANCE NUTRITION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,CDE,LDN
Authorized Official - Phone:610-275-3699
Mailing Address - Street 1:2500 DEKALB PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-2007
Mailing Address - Country:US
Mailing Address - Phone:610-275-3699
Mailing Address - Fax:610-275-3799
Practice Address - Street 1:2500 DEKALB PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-2007
Practice Address - Country:US
Practice Address - Phone:610-275-3699
Practice Address - Fax:610-275-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty