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Organization

NUTRACO LLC

Active
Other names
NutraSourceRD
Organization subpart
No

Provider details

NPI number
Authorized official
CHAYA SOKOL (CEO)
(718) 510-6776
Entity
Organization

Contact information

Practice address
5691 BROOKFIELD CIR W, FORT LAUDERDALE, FL 33312-6283
(718) 510-6776
Mailing address
121 MOUNTAIN VIEW DR, LAKEWOOD, NJ 08701-5857

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
283X00000X
Rehabilitation Hospital
310400000X
Assisted Living Facility
313M00000X
Nursing Facility/Intermediate Care Facility

Other

Enumeration date
04/28/2017
Last updated
07/17/2023
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