Provider Demographics
NPI:1275351678
Name:ROOTED NOURISH, LLC
Entity type:Organization
Organization Name:ROOTED NOURISH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWHOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-991-3295
Mailing Address - Street 1:125 SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9263
Mailing Address - Country:US
Mailing Address - Phone:859-991-3295
Mailing Address - Fax:
Practice Address - Street 1:125 SYLVAN DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-9263
Practice Address - Country:US
Practice Address - Phone:859-991-3295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty