Provider Demographics
NPI:1679838585
Name:CR NUTRITION AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CR NUTRITION AND WELLNESS, LLC
Other - Org Name:CARMEL M. RICKENBACH, MS, RD, LDN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:484-467-4538
Mailing Address - Street 1:715 NORTHBROOK RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1509
Mailing Address - Country:US
Mailing Address - Phone:484-456-4538
Mailing Address - Fax:610-444-0689
Practice Address - Street 1:1290 BALTIMORE PIKE
Practice Address - Street 2:SUITE 113A
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-7361
Practice Address - Country:US
Practice Address - Phone:484-467-4538
Practice Address - Fax:610-444-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty