Provider Demographics
NPI:1962278721
Name:REVIVAL SKILLS
Entity type:Organization
Organization Name:REVIVAL SKILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, HOLISTIC NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:NUTRITIONIST
Authorized Official - Phone:973-459-1978
Mailing Address - Street 1:411 MAPLE AVEUNE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108
Mailing Address - Country:US
Mailing Address - Phone:973-459-1978
Mailing Address - Fax:
Practice Address - Street 1:411 MAPLE AVEUNE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108
Practice Address - Country:US
Practice Address - Phone:973-459-1978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty