Provider Demographics
NPI:1194265983
Name:PEACHY NUTRITION LLC
Entity type:Organization
Organization Name:PEACHY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FATME
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUKHEIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-674-7459
Mailing Address - Street 1:310 SCHEPIS AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4933
Mailing Address - Country:US
Mailing Address - Phone:201-674-7459
Mailing Address - Fax:
Practice Address - Street 1:310 SCHEPIS AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-4933
Practice Address - Country:US
Practice Address - Phone:201-674-7459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty