Provider Demographics
NPI:1316257553
Name:CORPORATE WELLNESS NUTRITION LLC
Entity type:Organization
Organization Name:CORPORATE WELLNESS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-484-7720
Mailing Address - Street 1:150 MONUMENT RD STE 207
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1725
Mailing Address - Country:US
Mailing Address - Phone:800-203-8657
Mailing Address - Fax:800-258-1426
Practice Address - Street 1:150 MONUMENT RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:800-203-8657
Practice Address - Fax:800-258-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003782133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty