MEDICARE: ROOTED FOUNDATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1487592044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED FOUNDATIONS LLC

Provider Business Mailing Address
First Line	:	5201 BROMWICK DR
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-1909
Country	:	US
Telephone Number	:	937-307-8120
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 BROMWICK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-1909
Country	:	US
Telephone Number	:	937-307-8120
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEONA JOLLY
Credential	:
Telephone Number	:	937-307-8120

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ROOTED FOUNDATIONS LLC ” Practice Location

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