Provider Demographics
NPI:1881421402
Name:NOURISH CENTER
Entity type:Organization
Organization Name:NOURISH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, CCTP, CCAT
Authorized Official - Phone:215-858-0066
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-0508
Mailing Address - Country:US
Mailing Address - Phone:215-858-0066
Mailing Address - Fax:
Practice Address - Street 1:4060 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474
Practice Address - Country:US
Practice Address - Phone:215-858-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)