Provider Demographics
NPI:1598552762
Name:AUTUMN ROSE WELLNESS LLC
Entity type:Organization
Organization Name:AUTUMN ROSE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:RAUCHWERK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:908-309-1450
Mailing Address - Street 1:1216 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4221
Mailing Address - Country:US
Mailing Address - Phone:908-309-1450
Mailing Address - Fax:
Practice Address - Street 1:1216 N 8TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4221
Practice Address - Country:US
Practice Address - Phone:908-309-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty